QUALITY OF LIFE IN PATIENTS WITH OROPHARYNX CARCINOMAS: ASSESSMENT AFTER ACCELERATED RADIOTHERAPY WITH OR WITHOUT CHEMOTHERAPY VERSUS RADICAL SURGERY AND POSTOPERATIVE RADIOTHERAPY Abdelkarim S. Allal, MD, 1 Kevin Nicoucar, MD, 2 Nicolas Mach, MD, 3 Pavel Dulguerov, MD 2 1 Division of Radiation Oncology, University Hospital of Geneva, 1211 Geneva 14, Switzerland. E-mail: Abdelkarim.Allal@hcuge.ch 2 Division of Head and Neck Surgery, Geneva, University Hospital, 1211 Geneva 14, Switzerland 3 Division of Oncology, Geneva, University Hospital, 1211 Geneva 14, Switzerland Accepted 20 December 2002 Published online 15 May 2003 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/hed.10302 Abstract: Background. In oropharyngeal carcinomas, it is as- sumed that the effectiveness of the different treatment ap- proaches is roughly equivalent, whereas the functional outcome after radical radiotherapy (RT) is superior to that associated with primary surgery. The aim of this study is to assess quality of life (QoL) outcomes of patients after two treatment strategies: radical surgery with postoperative RT and accelerated concomitant boost RT with or without chemotherapy. Methods. Sixty patients who were disease free at least 1 year after treatment of oropharynx carcinoma were studied. Forty had been treated with radical RT (median tumor dose, 69.9 Gy in 5.5 weeks), and 20 had been treated with primary surgery and postoperative monofractionated RT (median dose, 60.2 Gy). Seven of the former patients received chemotherapy concomi- tantly with, and one before, RT. Functional outcome was as- sessed by the subjective Performance Status Scale for Head and Neck cancer (PSSHN) and the general QoL by the European Organization for Research and Treatment of Cancer Core QoL questionnaire (EORTC QLQ-C30). The unpaired t test was used to assess for significant differences between means. Results. By use of the PSSHN module, scores were gener- ally higher in the RT group, with a significant difference in the speech subscale (p = .005), a trend for a significant difference for the eating in public subscale (p = .08), and an insignificant dif- ference for the normalcy of diet subscale (p = .25). When ana- lyzed by tumor stage, no significant differences were observed for T1–2 tumors, whereas for patients with T3–4 tumors highly significant differences favoring the RT group became evident for all three subscales. Although no significant differences were ob- served using the EORTC QLQ C-30 functional scales, patients treated with primary surgery reported significantly more dyspnea (28 vs 12, p = .04) and appetite loss (30 vs 13, p = .05). In patients with T3–4 tumors, trends toward better scores favoring the RT group were observed for physical, role, emotional, and social functions, as well as a significantly better score for pain symptoms. Conclusions. Although for early stages no clear advantage in QoL outcome was noted for the RT group compared with the surgery group, for advanced-stage disease an advantage favor- ing radical RT seemed apparent. For those patients, if an equiva- lency between the two treatment strategies could be assumed regarding oncologic results, then nonsurgical treatment should Correspondence to: A. S. Allal QoL in Oropharyngeal Cancer HEAD & NECK October 2003 833