Table 27IMRT vs. 2DRT: Summary of studies of nasopharyngeal cancer

StudySettingOutcomenUnivariate p valueMultivariable p valueStudy designInitial groups comparable?Treatments in same time period?Well-done multivariable analysis?Study quality rating
Pow et al. 2006[28], RCTPrimary RTQuality of life452/6/12 mos.
SF-36
Role-Physical, 12 mo IMRT+ <.05, all other F/U NS
Bodily pain, 12 mo IMRT+ <.05, all other F/U NS
All other domains, all F/U
NS: Physical Function, Vitality, Social Functioning, Role-Emotional, Mental Health

EORTC QLQ-C30
Role Function-Revised, 12 mos. IMRT+ <.05, all other F/U NS
Diarrhea, 2 mos. IMRT-<.05, series IMRT- .009, other F/U NS
All other domains, all F/U
NS: Global Health, Global Health-Revised, Physical Function, Role Function, Emotional Function, Cognitive Function, Social Function, Fatigue, Nausea/Vomiting, Pain, Dyspnea, Insomnia, Appetite Loss, Constipation, Financial Difficulties
EORTC QLQ-H&N35
Swallowing, 12 mos. IMRT+ <.05, series IMRT+ .022, other F/U NS
Taste/Smell, 2 mos. IMRT+ <.05, all other F/U NS
Speech, 6 mos. IMRT+ <.05, 12 mos. IMRT+ <.05, series IMRT+ .053, 2 mos. NS Dry Mouth, series IMRT-.021, all other F/U NS Sticky Saliva, 2/6/12 mos. IMRT-<.05, series IMRT-<.001 Coughing, 6 mos. IMRT-<.05, all other F/U NS Weight Gain, 2 mos. IMRT-<.05, all other F/U NS
All other domains, all F/U NS: Pain, Social Eating, Social Contact, Sexuality, Teeth, Opening Mouth, Feeling Ill, Pain Killers, Nutrition Supplement, Feeding Tube, Weight Loss
ProspectiveYesYesNo ITTPoor
Wu et al. 2005[86]

Primary radiotherapy
Xerostomia380Acute, Gr ?, Δ-3, p NRRetrospectiveUnclearUnclearNot donePoor
Pow et al. 2006[28], RCTSalivary flow452/6/12 mo stimulated whole saliva flow
ANOVA IMRT+ <.003 Stimulated parotid saliva flow
ANOVA IMRT+ <.002
ProspectiveYesYesNo ITTPoor
Wu et al. 2005[86]Salivary flow380? mo, static secretion function, IMRT+ <.05
Laskar et al. 2008[75]Primary RT + split chemotherapyXerostomia36Acute, ≥ Gr 2, Δ-56, .002ProspectiveYesYesNot donePoor
Dysphagia36Acute, ≥ Gr 2, Δ-52, .01
Acute, ≥ Gr 3, Δ-30, .035
Not done
Mucositis36Acute, ≥ Gr 2, Δ-20, .066
Acute, ≥ Gr 3, Δ-37, .033
Not done
Skin toxicity36Acute, ≥ Gr 2, Δ-16, NS
Acute, ≥ Gr 3, Δ-42, .006
Not done
Locoregional control362 yr. Δ +16, NSNot enteredUnclear
Disease-free survival362 yr. Δ +12, NSNot enteredUnclear
Overall survival362 yr. Δ +14, NSNot enteredUnclear
Fang et al. 2007[32]Primary RT ± chemotherapy with unclear timingQuality of life9424–36 mos., EORTC QLQ-C30
Group means presented but no statistical test results given for all domains: Global Health, Physical Function, Role Function, Emotional Function, Cognitive Function, Social Function, Fatigue, Nausea/Vomiting, Pain, Dyspnea, Insomnia, Appetite Loss, Constipation, Diarrhea, Financial Difficulties

EORTC QLQ-H&N35
Group means presented but no statistical test results given for all domains: Pain, Swallowing, Taste/smell, Social eating, Social contract, Sexuality, Teeth, Opening mouth, Dry mouth, Sticky saliva, Coughing, Feeling ill
RetrospectiveUnclearNoOff-topicPoor
Fang et al. 2007[32]Xerostomia9424–36 mos., EORTC QLQ-H&N35 Dry Mouth item

Group means presented but no statistical test results given
Kam et al. 2007[41] (RCT)Primary RT ± intracavitary brachytherapyXerostomia56Acute, Gr 2–4, Δ-40, .002 Late, Gr 2–4, Δ-43, .001

1.5/6/12 mos., change in total from 6-item Xerostomia Scale, all F/U NS
ProspectiveYesYesYes ITTFair
Hsiung et al. 2006[72]Primary RT± concurrent chemotherapyXerostomia32Late, Gr 2–4, Δ-50 <.001RetrospectiveNoNoNot donePoor
Kam et al. 2007[41] (RCT)Salivary flow561.5/6/12 mos., stimulated whole saliva flow rate 12 mo IMRT+ <.01

Stimulated parotid saliva flow rate 1.5/6/12 mos. IMRT+ <.001

Abbreviations: Δ: change; Gr: grade; mos.: months; NR: not reported; NS: not significant; RT: radiotherapy; wks: weeks; yr: year;

From: Results

Cover of Comparative Effectiveness and Safety of Radiotherapy Treatments for Head and Neck Cancer
Comparative Effectiveness and Safety of Radiotherapy Treatments for Head and Neck Cancer [Internet].
Comparative Effectiveness Reviews, No. 20.
Samson DJ, Ratko TA, Rothenberg BM, et al.

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