Chin J Radiol 2004; 29: 21-28

Chin J Radiol 2004; 29: 21-28 21 [1-5] 1991 1998 [6-8] [9] 407 118 68-75 [10] 86-92

22 2002 3 2003 4 EORTC QLQ-C30 global health status 1 7 Likert s 1 2 3 4 physical functioning role functioning emotional functioning cognitive functioning social functioning 40 Gy 18 Gy 3 350 EORTC QLQ-C30 217 ---- 111 ---- 106 International Federation of Gynecology and Obstetrics FIGO IA IB IIA t SPSS 10.0 EORTC QLQ C-30 tumor < 3mm bulky endocervical Barrel-shaped cervix 217 29 80 63.17 10.05 60-69 35.0% 70-79 29.5% 77.0% 23.0% 36.9% 34.6% 8.3% European Organization for Research and Treatment of Cancer, EORTC EORTC QLQ-C30 [1-3] RTOGEORTC 1995 [11] EORTC QLQ-C30 29-80 63.17 10.05 217 100.0% 167 77.0% 50 23.0% 80 36.9% 75 34.6% 18 8.3% 35 16.1% 9 4.1% 0 0.0% 68 31.3% 149 68.7%

23 16.1% 4.1% 0.0% 31.3% 68.7% 27.4% 26.4% 23.6% 48.6% 46.8% 40.5% 35.1% 27.9% 26.1% 24.3% 49.1% 45.3% 33.0% 29.2% 46.8%, p < 0.001 24.3%, p = 0.004 40.5%, p = 0.041 13.5%, p = 0.050 45.3%, p = 0.008 14.2%, p = 0.029 n = 217 OP+RT RT X 2 p 1. 54 48.6% 52 49.1% 0.004.952 2. 20 18.0% 25 23.6% 1.022.312 3. 31 27.9% 48 45.3% 7.054**.008 4. 52 46.8% 25 23.6% 12.816***.000 5. 18 16.2% 28 26.4% 3.376.066 6. 39 35.1% 35 33.0% 0.108.742 7. 17 15.3% 16 15.1% 0.002.964 8. 45 40.5% 29 27.4% 4.193* 041 9. 27 24.3% 10 9.4% 8.500**.004 10. 22 19.8% 31 29.2% 2.610.106 11. 6 5.4% 15 14.2% 4.744*.029 12. 29 26.1% 24 22.6% 0.357.550 13. 14 12.6% 10 9.4% 0.557.455 14. 15 13.5% 6 5.7% 3.826*.050 * p<0.05, ** p<0.01, *** p<0.001 RT Radiotherapy OP Operation n = 217 OP+RT RT t p 64.70 23.16 58.73 19.55 2.039*.043 83.30 14.93 82.89 15.94 0.195.845 92.94 14.49 90.09 21.92 1.124.262 86.41 19.00 84.11 19.09 0.886.377 84.08 18.99 78.46 19.51 2.151*.033 93.54 13.88 88.68 19.59 2.101*.037 16.52 18.09 20.65 21.21-1.541.125 2.40 7.40 5.19 10.63-2.231*.027 7.36 15.51 12.42 18.70-2.166*.031 12.31 20.06 13.21 19.88-0.330.742 18.02 24.93 22.64 24.58-1.375.170 6.01 13.63 11.95 19.07-2.630**.009 21.32 25.74 11.32 21.52 3.110**.002 11.11 18.71 16.03 21.69-1.788.075 6.31 15.90 11.32 20.52-2.006*.046 * p<0.05, ** p<0.01, *** p<0.001

24 QLQ-C30 EORTC [18] p = 0.043 p = 0.033 p = 0.037 p = 0.027 p = 0.031 p = 0.009 p = 0.046 p = 0.002 46.8% vs. 23.6%, p < 0.001 24.3% vs. 9.4%, p = 0.004 40.5% vs. 27.4%, p = 0.041 13.5% vs. 5.7%, p = 0.050 45.3% vs. 27.9%, p = 0.008 14.2% vs. 5.4%, p = 0.029 Barter [19] 30% Fiorica [20] 24% 1994 2002 7.00% 4.87% 2001 1991 27.9% [9] EORTC QLQ-C30 Montz [21] 23.6%, p < 0.001 Barnes [22] 46.8% vs. 24.3% vs. 9.4%, p = 0.004 Magrina [23] 20% 48.6% 46.8% 40.5% 35.1% 49.1% 45.3% 33.0% 15] Jereczek-Fossa [12] 30% Bye [15] [12- Martinbeau [24] 23.4% Werngren-Elgstrom [25] 54 41% 5% 28% 5% 6% 10% 7% 15% 22% [23, 26] 40.5% vs. 27.4%, p = 0.041 Klee [16] 118 Parkin [17] 5 11 35% Magrina [23] 21% Farquharson [27] 30

25 63% 23% 26% macroscopic [10, 15, 17, 19, 24, 37] [28] [29] 13.5% vs. 5.7%, p = 0.050 3-4 Bye [34] Anderson [30] Feeney [31] 40-50% Perez [10] 45.3% vs. 27.9%, p = 0.008 14.2% vs. 5.4%, p = 0.029 45.3% vs. 27.9%, p = 0.008 Crook [32] [33] 0.6% Bye [34] 3-4 Eifel Grigsby [35] Christman [36] 0.029 14.2% vs. 5.4%, p = EORTC QLQ C-30 t- CH02000031 p = 0.043 p = 0.033 p = 0.037 p = 0.027 p = 0.031 p = 0.009 p = 0.046 Morita [37] microscopic 1. Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. JNCI 1993; 85: 365-376 2. Bjordal K, Ahlner-Elmqvist M, Hammerlid E, et al. A

26 prospective study of quality of life in head and neck cancer patients. Part II: longitudinal data. Laryngoscope 2001; 111: 1440-1452 3. Bjordal K, de Graeff A, Fayers PM, et al. A 12 country field study of the EORTC QLQ-C30 (version 3.0) and the head and neck cancer specific module (EORTC QLQ-H&N35) in head and neck patients. EORTC Quality of Life Group. Eur J Cancer 2000; 36: 1796-1807 4. Chang VT, Thaler HT, Polyak TA, Kornblith AB, Lepore JM, Portenoy RK. Quality of life and survival. The role of multidimensional symptom assessment. Cancer 1998; 83: 173-179 5. Cooper CL. Self transcendence and emotional wellbeing in women with advanced breast cancer. Oncol Nursing Forum 1991; 18: 857-862 6. The WHOQOL group. Development of World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med 1998; 28: 551-558 7. The WHOQOL group. The World Health Organization Quality of Life assessment (WHOQOL): Position paper from the World Health Organization. Soc Sci Med 1995; 41: 1403-1409 8. The WHOQOL group. The World Health Organization Quality of Life assessment (WHOQOL): Development and general psychometric properties. Soc Sci Med 1998; 46: 1569-1585 9. 2002 http:www.doh.gov.twstatisticindex.htm 10. Perez CA. Uterine cervix. In: Perez CA, Brady LW, editors. Principles and practice of radiation oncology. Third edition. Philadelphia: Lippincott-Raven; 1998: 1733-1834 11. Rubin P, Constine LS, Fajardo LF, et al. RTOG late effects working group. Overview late effects of normal tissues (LENT) scoring system. Int J Radiat Oncol Biol Phys 1995; 31: 1041-1042 12. Jereczek-Fossa BA, Marsiglia HR, Orecchia R. Radiotherapy-related fatigue. Crit Rev Oncol Hematol 2002; 41: 317-325 13. Barnes EA, Bruera E. Fatigue in patients with advanced cancer: a review. Int J of Gynecol Cancer 2002; 12: 424-428 14. Morrow GR, Andrews PL, Hickok JT, Roscoe JA, Matteson S. Fatigue associated with cancer and its treatment. 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28 Long-term Quality of Life for Patients with Early Stage Uterine Cervical Carcinoma after Treatment WEI-CHUNG HSU 1 NA-NA CHUNG 2 YU-CHIA CHEN 3 SUE-CHING CHAN 4 LAI-LEI TING 2 CHUNG-HUANG TSAI 5 HSUEH-FENG WANG 6 PO-MING WANG 1 GAU-DE LIN 7 Department of Radiation Oncology 1, Family Medicine 5, Nursing 6, General Surgery 7, Cheng-Ching General Hospital Division of Radiation Oncology, Department of Oncology 2, National Taiwan University Hospital Department of Social Work 3, National Pingtung University of Science and Technology Department of Pharmacy 4, Buddhist Tzu-Chi General Hospital To compare the difference between treatment modalities for long-term quality of life (QoL) in patients with early stage uterine cervical carcinoma. From March 2002 to April 2003, two hundred and seventeen patients of two institutions were invited to participate. Inclusive patients were followed for at least 2 years after the completion of the treatment. They were divided into 2 groups by different treatment modalities: surgery with postoperative radiation therapy (OP+RT) and radiation therapy alone (RT alone). QoL were assessed by means of the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ C-30) and side effects for uterine cervical cancer after treatment. Relative high side effects in early stage uterine cervical cancer patient treated by OP+RT were: constipation (46.8%, p < 0.001), edema of lower extremities (24.3%, p = 0.004), urine incontinence (40.5%, p = 0.041) and hot flush (13.5%, p = 0.050). Relative high side effects in early stage uterine cervical cancer patient treated by RT alone were: diarrhea (45.3%, p = 0.008) and increased vaginal discharge (14.2%, p = 0.029). The EORTC QLQ C-30 QoL items were significant better in OP+RT groups as comparison with RT alone group, including global health status (p = 0.043), cognitive function (p = 0.033), social function (p = 0.037), nauseavomiting (p = 0.027), pain (p = 0.031), poor appetite (p = 0.009) and financial problem (p = 0.009). Constipation was worse significantly in OP+RT group than in RT alone group (p = 0.002). Our study provided comparison and analysis of long-term QoL and side effects in early stage uterine cervical cancer patients treated by different modalities. These data were helpful for clinical physician not only for selecting treatment modalities when concerning with QoL of the patients, but also for rehabilitation and supportive care of the patients after treatment. Key words: EORTC; Quality of life; Radiotherapy; Uterine cervical cancer