Session Item

We assessed the serial changes in health related quality of life(HR-QoL) parameters in patients with locally advanced nasopharyngeal carcinoma(LA-NPC) on a  phase 2 clinical trial of gemcitabine and cisplatin(GC) based neoadjuvant chemotherapy(NACT) followed by dysphagia optimised intensity modulated radiotherapy(Do-IMRT) with concurrent weekly cisplatin.

Patients with stage II-IVA NPC received 3 cycles of 3-weekly NACT with cisplatin and gemcitabine followed by Do-IMRT(65Gy,60Gy,54Gy/30fractions/6weeks to high-risk, intermediate-risk and low-risk PTVs respectively by simultaneous integrated boost) with concurrent weekly cisplatin. Serial changes in HR-QoL were assessed by European Organisation for Research and Treatment of Cancer Quality of Life core-30 and Head and Neck Cancer Module(EORTC QLQ C-30 and H&N-35) questionnaire(version 3.0) at baseline, 3 weeks after completion of NACT, immediately and 3 and 6 months after completion of CRT. Serial changes in HR-QoL parameters at all time points were analysed by Friedman test and pair wise comparison was done by Wilcoxon signed rank test. Bonferroni correction for multiple comparisons was applied to control the type-I error.

Out of a total of 30 screened patients, 23 were eligible and recruited in this study from 25-Sep-2020 to 01-Jan-2022. The CR rate and ORR after CRT were 78.6% and 92.9% respectively. The median duration of follow-up was 13.06 months. The actuarial PFS and OS rates were 100% and 90.3% at 1 year and 80.8% and 73.6% at 2 years, respectively. From a median global health status(GHS) score of 74.99 at baseline, there was an initial rise in the score after NACT(83.33), followed by a precipitous dip after CRT(33.33) and a subsequent steady rise in the scores at 3 months(58.33) and 6 months(83.33) after completion of CRT (p<0.001). Pertaining to physical, role, emotional, cognitive and social functioning, there was a dip in the median functional scale scores after NACT, which further intensified after completion of CRT, followed by a steady rise and partial recovery of the scores at 3 and 6 months after completion of CRT, the serial changes being all statistically significant. The median symptom scale scores for most of the domains of EORTC QLQ C-30 and H&N-35, particularly pain, swallowing, opening mouth, speech, dry mouth, sticky saliva and weight loss, peaked after CRT, followed by significant declines at 3 and 6 months after completion of CRT.

GC-based NACT followed by Do-IMRT with concomitant cisplatin was feasible and led to a favourable quality of life profile. There was an initial rise in the median GHS score after NACT, reflecting the high ORR of NACT followed by a precipitous dip after CRT due to the acute haematological and non-haematological toxicities of CRT. Subsequently there was a steady rise in the scores at 3 and 6 months after completion of CRT due to tumour response to CRT and resolution of acute toxicities.