==== Front Medicine (Baltimore)Medicine (Baltimore)MEDIMedicine0025-79741536-5964Wolters Kluwer Health 30024547MD-D-18-0290710.1097/MD.0000000000011545115453800Research ArticleObservational StudyQuality of life in Chinese patients with laryngeal cancer after radiotherapy Mu Ji-Wei MMaZhang Mei-Jia MMaLuan Bi-Qi MMbWu Jian MBbSun Ping MDc∗Aslam. Muhammad Shahzad a Department of Otolaryngology, First Affiliated Hospital of Jiamusi Universityb Department of otolaryngology, Second Affiliated Hospital of Jiamusi University, Jiamusic Department of Anatomy, Mudanjiang Medical University, Mudanjiang, China.∗ Correspondence: Ping Sun, Department of Anatomy, Mudanjiang Medical University, No.3 Tongxiang Road, Aiming District, Mudanjiang 157011, China (e-mail: Pingsun5218@163.com).7 2018 20 7 2018 97 29 e1154523 4 2018 24 6 2018 Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc.2018This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0Abstract This retrospective study explored the quality of life (QoL) in Chinese patients with laryngeal cancer (LC) after radiotherapy. Fifty-nine eligible patients with Tis-T4 LC were included in this retrospective study. All patients received radiotherapy. Outcomes were measured by the core measure Questionnaire-C30 (QLQ-C30), and the disease-specific Head & Neck cancer module (QLQ-H&N35). All outcomes were assessed before and 3 months after the radiotherapy. Three months after the radiotherapy, all items of QLQ-C30 and QLQ-H&N35 scales changed significantly (P < .05), except the social functioning (P = .09), role activities (P = .81), and global (P = .12) in QLQ-C30 scale and social contacts (P = 1.00), teeth problems (P = .21), trismus (P = 1.00), and feeling ill (P = .07) in QLQ-H&N35 scale, compared with these items before the radiotherapy. The results of this study showed that most items of QoL changed significantly after 3 months of radiotherapy in Chinese patients with LC. Keywords laryngeal cancerquality of liferadiotherapyOPEN-ACCESSTRUE ==== Body 1 Introduction Laryngeal cancer (LC) is one of the most common malignant types of cancers in head and neck.[1–3] Most of such patients were diagnosed with squamous cell cancer, chiefly on the epithelial lining of the larynx.[4,5] It has been estimated that the rates of incidence and mortality in Chinese patients with LC were about 1.54 per 100,000 and 0.91 per 100,000, respectively by 2010.[6] Although its incidence is relatively lower compared with other cancers, it severely affects the quality of life (QoL) in such patients.[7–9] Additionally, its mortality rate also increases year by year.[6,10] Radiotherapy is utilized as a primary treatment for patients with early LC, and has achieved good survival outcome.[11] It has also been reported that radiotherapy may affect the voice quality and health-related QoL in patients with LC.[12–15] Several studies have evaluated the impact of radiotherapy on voice in patients with LC.[16–18] However, no inconsistent results were demonstrated from those studies.[16–18] Presently, limited evidence is available to support that radiotherapy can improve the QoL in Chinese patients with LC. Thus, in this retrospectively study, we investigated the effect of radiotherapy on QoL in patients with LC after radiotherapy among Chinese population. 2 Methods and materials 2.1 Ethics statement This study was approved by the Ethical Committees of First Affiliated Hospital of Jiamusi University, and Second Affiliated Hospital of Mudanjiang Medical University. Informed consent and required document were obtained from all patients in this study. 2.2 Design This retrospective study included 59 eligible Chinese patients with Tis-T4 LC after radiotherapy. All the included patients completed the radiotherapy. QoL and voice quality were measured and evaluated before and 3 months after the treatment. 2.3 Subjects Patients with Tis-T4 LC after radiotherapy were included in this study. Inclusion criteria included eligible patients older than 18 years. All patients completed the radiotherapy treatment. However, patients were excluded if they received primary surgery or radiotherapy before this study, and incomplete data. 2.4 Therapeutic methods All patients received radiotherapy to the primary tumor with 2 Gy fractions, once daily, for a total of 22 days, and total fractions up to 44 Gy. After that, a boost dose of 2 Gy fractions, twice daily for a total of 24 Gy to the primary tumor and involved lymph nodes. 2.5 Outcome measurements The QoL was measured by the QoL core measure Questionnaire-C30 (QLQ-C30), consisting of 15 items, and the disease-specific Head & Neck cancer module (QLQ-H&N35), comprising 18 items.[19–21] All of the scales and single item of QLQ-C30 range from 0 to 100. A low scale score represents a lower response level. The QLQ-H&N35 scale varies from 0 to 100. As for functional scales, a higher score means better QoL, whereas for the symptom scales, the higher score would indicate heavier burden. All outcome measurements were assessed before and 3 months after the radiotherapy. 2.6 Statistical methods All data of characteristics and outcome measurements were analyzed by SPSS Statistics 17.0 (IBM Corp., Armonk, NY). t Test was used to analyze all the outcome data before and 3 months after the radiotherapy. P < .05 was defined as the statistical significance. 3 Results The characteristics of 59 included eligible patients are summarized in Table 1. These characteristics presented with age, sex, and race, performance status of tumor, primary tumor location, T category, and chemotherapy. Table 1 Patient characteristics (n = 59). Three months after the radiotherapy, all items of QLQ-C30 changed significantly (P < .05), except the social functioning (P = 0.09), role activities (P = .81), and global (P = .12), compared with these items before the radiotherapy (Table 2). Table 2 Comparison of QLQ-C30 before and 3-month after radiotherapy. Three months after the radiotherapy, patients with LC showed dramatically change in all items of QLQ-H&N35, except the social contacts (P = 1.00), teeth problems (P = .21), trismus (P = 1.00), and feeling ill (P = .07), compared to them before the radiotherapy (Table 3). Table 3 Comparison of QLQ-H&N35 before and 3-month after radiotherapy. 4 Discussion Several earlier studies have addressed this issue of patients with LC receiving radiotherapy.[22,23] However, the methodological quality of these studies was quite poor. Additionally, limited data are still available in Chinese patients with LC. In this study, we specifically explored the effect of radiotherapy on QoL in Chinese patients with LC. Previous published studies have found that radiotherapy significantly impacted the patients with LC. One study demonstrated that after radiotherapy for LC, there was a temporary deterioration in physical functioning and symptoms, because of the treatment.[24] Fortunately, emotional functioning and mood improved significantly after the treatment.[24] The other study found that after accelerated radiotherapy, high local tumor control was achieved, and speech and swallowing function were maintained, although long-term adverse events of dry mouth, sticky saliva, and changes in taste/smell occurred in patients with LC.[25] The results of another study showed that patients with supraglottic tumors experienced more improvement in health-related QoL patients with glottic tumors after radiotherapy.[26] In this study, we explored the effect of radiotherapy on the QoL in patients with LC among Chinese population. The results of this study showed that after 3 months radiotherapy, the QoL of patients changed significantly, measured by QLQ-C30 scale, except the social functioning, role activities, and global, and QLQ-H&N35 scale, except the social contacts, teeth problems, trismus, and feeling ill, compared these items before the radiotherapy. It indicates that radiotherapy greatly affects the QoL in Chinese patients with LC. This study suffers from several limitations. First, this retrospective study did not include a control group. Second, the number of patients is quite small in this study. Third, the follow-up period is relative short, that is 3 months, in this study. All those limitations may impact the results of this study. Future studies should avoid these limitations. 5 Conclusion The results of this study showed that radiotherapy may significantly impact the QoL in Chinese patients with LC 3 months after radiotherapy. Author contributions Conceptualization: Ping Sun, Ji-wei Mu, Mei-jia Zhang, Bi-qi Luan, Jian Wu. Data curation: Ping Sun, Ji-wei Mu, Bi-qi Luan. Formal analysis: Bi-qi Luan. Investigation: Ping Sun. Methodology: Mei-jia Zhang. Project administration: Ping Sun. Resources: Ji-wei Mu, Mei-jia Zhang. Software: Mei-jia Zhang. Supervision: Ji-wei Mu, Jian Wu. Validation: Mei-jia Zhang, Jian Wu. Visualization: Ping Sun, Ji-wei Mu, Mei-jia Zhang, Jian Wu. Writing – original draft: Ping Sun, Ji-wei Mu, Mei-jia Zhang, Bi-qi Luan, Jian Wu. Writing – review & editing: Ping Sun, Ji-wei Mu, Mei-jia Zhang, Bi-qi Luan, Jian Wu. Abbreviations: LC = laryngeal cancer, QLQ-C30 = core measure Questionnaire- C30, QLQ-H&N35 = disease-specific Head & Neck cancer module, QoL = quality of life. J-WM and M-JZ these authors contributed equally to this study. The authors report no conflicts of interest. This work was supported in part by The Key Project of the Heilongjiang Health Bureau (2017-317) and The Innovation and Training Project of Heilongjiang Provincial College Students (201710229055). ==== Refs References [1] Luo XN Chen LS Zhang SY Effectiveness of chemotherapy and radiotherapy for laryngeal preservation in advanced laryngeal cancer: a meta-analysis and systematic review . Radiol Med 2015 ;120 :1153–69 .25981380 [2] Salvador-Coloma C Cohen E Multidisciplinary care of laryngeal cancer . J Oncol Pract 2016 ;12 :717–24 .27511718 [3] Britt CJ Gourin CG Contemporary management of advanced laryngeal cancer . Laryngoscope Investig Otolaryngol 2017 ;2 :307–9 . [4] Gallina S Sireci F Lorusso F The immuno-histochemical peptidergic expression of leptin is associated with recurrence ofmalignancy in laryngeal squamous cell carcinoma . Acta Otorhinolaryngol Ital 2015 ;35 :15–22 .26015646 [5] MegwaluF UC Sikora AG Survival outcomes in advanced laryngeal cancer . JAMAOtolaryngol Head Neck Surg 2014 ;140 :855–60 . [6] Zhang SS Xia QM Zheng RS Laryngeal cancer incidence and mor-tality in China, 2010 . J Cancer Res Ther 2015 ;11 :C143–8 .26506866 [7] Kucuk H Kurnaz SC Kutlar G Treatment expectations and quality of life outcomes of patients with laryngeal cancer based on different treatment methods . Eur Arch Otorhinolaryngol 2015 ;272 :1245–50 .24789062 [8] Stewart MG Chen AY Stach CB Outcomes analysis of voice and quality of life in patients with laryngeal cancer . Arch Otolaryngol Head Neck Surg 1998 ;124 :143–8 .9485104 [9] García-León FJ García-Estepa R Romero-Tabares A Treatment of advanced laryngeal cancer and quality of life. Systematic review . Acta Otorrinolaringol Esp 2017 ;68 :212–9 .28351474 [10] Robertson SM Yeo JC Sabey L Effects of tumor staging and treatment modality on functional outcome and quality of life after treatment for laryngeal cancer . Head Neck 2013 ;35 :1759–63 .23483635 [11] Koyfman SA Hunter GK Reddy CA Definitive radiotherapy for early (T1-T2) glottic squamous cell carcinoma: a 20 year Cleveland Clinic experience . Radiat Oncol 2012 ;7 :193.23164282 [12] Mouw KW Solanki AA Stenson KM Performance and quality of life outcomes for T4 laryngeal cancer patients treated with induction chemotherapy followed by chemoradiotherapy . Oral Oncol 2012 ;48 :1025–30 .22621836 [13] Karabulut B Başaran B Yenice H The relationship between operation type, adjuvant radiation therapy, spinal accessory nerve and quality of life in patients with laryngeal cancer . Kulak Burun Bogaz Ihtis Derg 2013 ;23 :153–62 .23682939 [14] Al-Mamgani A Tans L van Rooij P A single-institutional experience of 15 years of treating T3 laryngeal cancer with primary radiotherapy, with or without chemotherapy . Int J Radiat Oncol Biol Phys 2012 ;83 :1000–6 .22099030 [15] Adams G Burnett R Mills E Objective and subjective changes in voice quality after radiotherapy for early (T1 or T2, N0) laryngeal cancer: a pilot prospective cohort study . Head Neck 2013 ;35 :376–80 .22367882 [16] Bibby JR Cotton SM Perry A Voice outcomes after radiotherapy treatment for early glottic cancer: assessment using multidimensional tools . Head Neck 2008 ;30 :600–10 .18098302 [17] Niedzielska G Niedzielski A Toman D Voice after radiotherapy of the larynx carcinoma . Radiother Oncol 2010 ;97 :276–80 .20951449 [18] Leeper HA Parsa V Jamieson DG Acoustical aspects of vocal function following radiotherapy for early T1a laryngeal cancer . J Voice 2002 ;16 :289–302 .12150383 [19] Aaronson NK Ahmedzai S Bergman B The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology . J Natl Cancer Inst 1993 ;85 :365–76 .8433390 [20] Bjordal K Hammerlid E Ahlner-Elmqvist M 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 :1796–807 .10974628 [21] Bjordal K Hammerlid E Ahlner-Elmqvist M Quality of life in head and neck cancer patients: validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire H&N35 . J Clin Oncol 1999 ;17 :1008–19 .10071296 [22] List MAL Ritter-Sterr CA Baker TM Longitudinal assessment of quality of life in laryngeal cancer patients . Head Neck 1996 ;18 :1–0 .8774916 [23] Morton RP Laryngeal cancer: quality-of-life and costeffectiveness . Head Neck 1997 ;19 :243–50 .9213101 [24] de Graeff A de Leeuw RJ Ros WJ A prospective study on quality of life of laryngeal cancer patients treated with radiotherapy . Head Neck 1999 ;21 :291–6 .10376747 [25] Janssens GO Langendijk JA Terhaard CH Quality-of-life after radiotherapy for advanced laryngeal cancer: results of a phase III trial of the Dutch Head and Neck Society . Radiother Oncol 2016 ;119 :213–20 .27165613 [26] Tuomi L Karlsson T Johansson M Health-related quality of life and voice following radiotherapy for laryngeal cancer-a comparison between glottic and supraglottic tumours . Acta Oncol 2015 ;54 :73–9 .24914482