Skip to main content
Top
Published in: Strahlentherapie und Onkologie 6/2015

01-06-2015 | Original Article

Residual deficits in quality of life one year after intensity-modulated radiotherapy for patients with locally advanced head and neck cancer

Results of a prospective study

Authors: PD Dr. med. Silke Tribius, Marieclaire Raguse, Christian Voigt, PD Dr. med. Adrian Münscher, PD. Dr. med. Dr. dent. Alexander Gröbe, PD Dr. med. Dr. dent., PD Dr. med. Cordula Petersen, Prof. Dr. med., PD Dr. med. Andreas Krüll, PD Dr. phil. Corinna Bergelt, Prof. Dr. Susanne Singer

Published in: Strahlentherapie und Onkologie | Issue 6/2015

Login to get access

Abstract

Purpose

Patients with locally advanced head and neck cancer (LAHNC) undergo life-changing treatments that can seriously affect quality of life (QoL). This prospective study examined the key QoL domains during the first year after intensity-modulated radiotherapy (IMRT) and identified predictors of these changes in order to improve patient outcomes.

Patients and methods

A consecutive series of patients with LAHNC completed the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core module (QLQ-C30) and the HNC-specific QLQ-HN35 before (t0) and at the end (t1) of definitive or adjuvant IMRT, then at 6–8 weeks (t2), 6 months (t3), and 1 year (t4) after IMRT.

Results

Patients (n = 111) completing questionnaires at all five time points were included (baseline response rate: 99 %; dropout rate between t0 and t4: 5 %). QoL deteriorated in all domains during IMRT and improved slowly during the first year thereafter. Many domains recovered to baseline values after 1 year but problems with smelling and tasting, dry mouth, and sticky saliva remained issues at this time. Increases in problems with sticky saliva were greater after 1 year in patients with definitive versus adjuvant IMRT (F = 3.5, P = 0.05).

Conclusion

QoL in patients with LAHNC receiving IMRT takes approximately 1 year to return to baseline; some domains remain compromised after 1 year. Although IMRT aims to maintain function and QoL, patients experience long-term dry mouth and sticky saliva, particularly following definitive IMRT. Patients should be counseled at the start of therapy to reduce disappointment with the pace of recovery.
Literature
1.
go back to reference Grégoire V, Lefebvre JL, Licitra L, Felip E, on behalf of the EHNS-ESMO-ESTRO Guidelines Working Group (2010) Squamous cell carcinoma of the head and neck: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 21(Suppl 5):v184–v186 Grégoire V, Lefebvre JL, Licitra L, Felip E, on behalf of the EHNS-ESMO-ESTRO Guidelines Working Group (2010) Squamous cell carcinoma of the head and neck: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 21(Suppl 5):v184–v186
3.
go back to reference Trotti A, Pajak TF, Gwede CK, Paulus R, Cooper J, Forastiere A, Ridge JA, Watkins-Bruner D, Garden AS, Ang KK, Curran W (2007) TAME: development of a new method for summarising adverse events of cancer treatment by the Radiation Therapy Oncology Group. Lancet Oncol 8:613–624CrossRefPubMed Trotti A, Pajak TF, Gwede CK, Paulus R, Cooper J, Forastiere A, Ridge JA, Watkins-Bruner D, Garden AS, Ang KK, Curran W (2007) TAME: development of a new method for summarising adverse events of cancer treatment by the Radiation Therapy Oncology Group. Lancet Oncol 8:613–624CrossRefPubMed
4.
go back to reference Hörmann K, Sadick H (2013) Role of surgery in the management of head and neck cancer: a contemporary view of the data in the era of organ preservation. J Laryngol Otol 127:121–127CrossRefPubMed Hörmann K, Sadick H (2013) Role of surgery in the management of head and neck cancer: a contemporary view of the data in the era of organ preservation. J Laryngol Otol 127:121–127CrossRefPubMed
5.
go back to reference Bhide SA, Nutting CM (2010) Advances in radiotherapy for head and neck cancer. Oral Oncol 46:439–441CrossRefPubMed Bhide SA, Nutting CM (2010) Advances in radiotherapy for head and neck cancer. Oral Oncol 46:439–441CrossRefPubMed
6.
go back to reference Jensen SB, Pedersen AM, Reibel J, Nauntofte B (2003) Xerostomia and hypofunction of the salivary glands in cancer therapy. Support Care Cancer 11:207–225PubMed Jensen SB, Pedersen AM, Reibel J, Nauntofte B (2003) Xerostomia and hypofunction of the salivary glands in cancer therapy. Support Care Cancer 11:207–225PubMed
7.
go back to reference Tribius S, Sommer J, Prosch C, Bajrovic A, Muenscher A, Blessmann M, Kruell A, Pertsen C, Todorovic M, Tennstedt P (2013) Xerostomia after radiotherapy. What matters—mean total dose or dose to each parotid gland. Strahlenther Onkol 189:216–222CrossRefPubMed Tribius S, Sommer J, Prosch C, Bajrovic A, Muenscher A, Blessmann M, Kruell A, Pertsen C, Todorovic M, Tennstedt P (2013) Xerostomia after radiotherapy. What matters—mean total dose or dose to each parotid gland. Strahlenther Onkol 189:216–222CrossRefPubMed
8.
go back to reference Harari PM (2005) Promising new advances in head and neck radiotherapy. Ann Oncol 16 (Suppl 6):vi13–vi19PubMed Harari PM (2005) Promising new advances in head and neck radiotherapy. Ann Oncol 16 (Suppl 6):vi13–vi19PubMed
9.
go back to reference Veldeman L, Madani I, Hulstaert F, De Meerleer G, Mareel M, De Neve W (2008) Evidence behind use of intensity-modulated radiotherapy: a systematic review of comparative clinical studies. Lancet Oncol 9:367–375CrossRefPubMed Veldeman L, Madani I, Hulstaert F, De Meerleer G, Mareel M, De Neve W (2008) Evidence behind use of intensity-modulated radiotherapy: a systematic review of comparative clinical studies. Lancet Oncol 9:367–375CrossRefPubMed
10.
go back to reference Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, Kish JA, Kim HE, Cmelak AJ, Rotman M, Machtay M, Ensley JF, Chao KS, Schultz CJ, Lee N, Fu KK, Radiation Therapy Oncology Group 9501/Intergroup (2004) Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350:1937–1944CrossRefPubMed Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, Kish JA, Kim HE, Cmelak AJ, Rotman M, Machtay M, Ensley JF, Chao KS, Schultz CJ, Lee N, Fu KK, Radiation Therapy Oncology Group 9501/Intergroup (2004) Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 350:1937–1944CrossRefPubMed
11.
go back to reference Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefèbvre JL, Greiner RH, Giralt J, Maingon P, Rolland F, Bolla M, Cognetti F, Bourhis J, Kirkpatrick A, van Glabbeke M, European Organization for Research and Treatment of Cancer Trial 22931 (2004) Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350:1945–1952CrossRefPubMed Bernier J, Domenge C, Ozsahin M, Matuszewska K, Lefèbvre JL, Greiner RH, Giralt J, Maingon P, Rolland F, Bolla M, Cognetti F, Bourhis J, Kirkpatrick A, van Glabbeke M, European Organization for Research and Treatment of Cancer Trial 22931 (2004) Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350:1945–1952CrossRefPubMed
12.
go back to reference Bjordal K, de Graeff A, Fayers PM, Hammerlid E, van Pottelsberghe C, Curran D, Ahlner-Elmqvist M, Maher EJ, Meyza JW, Brédart A, Söderholm AL, Arraras JJ, Feine JS, Abendstein H, Morton RP, Pignon T, Huguenin P, Bottomly A, Kaasa S (2000) 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 36:1796–1807CrossRefPubMed Bjordal K, de Graeff A, Fayers PM, Hammerlid E, van Pottelsberghe C, Curran D, Ahlner-Elmqvist M, Maher EJ, Meyza JW, Brédart A, Söderholm AL, Arraras JJ, Feine JS, Abendstein H, Morton RP, Pignon T, Huguenin P, Bottomly A, Kaasa S (2000) 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 36:1796–1807CrossRefPubMed
13.
go back to reference King MT (1996) The interpretation of scores from the EORTC quality of life questionnaire QLQ-C30. Qual Life Res 5:555–567CrossRefPubMed King MT (1996) The interpretation of scores from the EORTC quality of life questionnaire QLQ-C30. Qual Life Res 5:555–567CrossRefPubMed
14.
go back to reference Singer S, Wollbrück D, Wulke C et al (2009) Validation of the EORTC QLQ-C30 and EORTC QLQ-H & N35 in laryngeal cancer patients after surgery. Head Neck 31:64–76CrossRefPubMed Singer S, Wollbrück D, Wulke C et al (2009) Validation of the EORTC QLQ-C30 and EORTC QLQ-H & N35 in laryngeal cancer patients after surgery. Head Neck 31:64–76CrossRefPubMed
15.
go back to reference Singer S, Arraras J, Chie WC, Fisher S, Galalae R, Hammerlid E, Nicolatou-Galitis O, Schmalz C, Verdonck-de Leeuw IM, Gamper E, Keszte J, Hofmeister D (2013) Performance of the EORTC questionnaire for the assessment of quality of life in head and neck cancer patients EORTC QLQ-H & N35: a methodological review. Qual Life Res 22:1927–1941CrossRefPubMed Singer S, Arraras J, Chie WC, Fisher S, Galalae R, Hammerlid E, Nicolatou-Galitis O, Schmalz C, Verdonck-de Leeuw IM, Gamper E, Keszte J, Hofmeister D (2013) Performance of the EORTC questionnaire for the assessment of quality of life in head and neck cancer patients EORTC QLQ-H & N35: a methodological review. Qual Life Res 22:1927–1941CrossRefPubMed
16.
go back to reference Fayers PM, Aaronson NK, Bjordal K et al (2001) The EORTC QLQ-C30 Scoring Manual, 3rd edn. European Organisation for Research and Treatment of Cancer, Brussels Fayers PM, Aaronson NK, Bjordal K et al (2001) The EORTC QLQ-C30 Scoring Manual, 3rd edn. European Organisation for Research and Treatment of Cancer, Brussels
17.
go back to reference Pow EH, Kwong DL, McMillan AS, Wong MC, Sham JS, Leung LH, Leung WK (2006) Xerostomia and quality of life after intensity-modulated radiotherapy vs. conventional radiotherapy for early-stage nasopharyngeal carcinoma: initial report on a randomized controlled clinical trial. Int J Radiat Oncol Biol Phys 66:981–991CrossRefPubMed Pow EH, Kwong DL, McMillan AS, Wong MC, Sham JS, Leung LH, Leung WK (2006) Xerostomia and quality of life after intensity-modulated radiotherapy vs. conventional radiotherapy for early-stage nasopharyngeal carcinoma: initial report on a randomized controlled clinical trial. Int J Radiat Oncol Biol Phys 66:981–991CrossRefPubMed
18.
go back to reference Braam PM, Roesink JM, Raaijmakers CP, Busschers WB, Terhaard CH (2007) Quality of life and salivary output in patients with head-and-neck cancer five years after radiotherapy. Radiat Oncol 2:3CrossRefPubMedCentralPubMed Braam PM, Roesink JM, Raaijmakers CP, Busschers WB, Terhaard CH (2007) Quality of life and salivary output in patients with head-and-neck cancer five years after radiotherapy. Radiat Oncol 2:3CrossRefPubMedCentralPubMed
19.
go back to reference Fang FM, Chien CY, Tsai WL, Chen HC, Hsu HC, Lui CC, Huang TL, Huang HY (2008) Quality of life and survival outcome for patients with nasopharyngeal carcinoma receiving three-dimensional conformal radiotherapy vs. intensity-modulated radiotherapy—a longitudinal study. Int J Radiat Oncol Biol Phys 72:356–364CrossRefPubMed Fang FM, Chien CY, Tsai WL, Chen HC, Hsu HC, Lui CC, Huang TL, Huang HY (2008) Quality of life and survival outcome for patients with nasopharyngeal carcinoma receiving three-dimensional conformal radiotherapy vs. intensity-modulated radiotherapy—a longitudinal study. Int J Radiat Oncol Biol Phys 72:356–364CrossRefPubMed
20.
go back to reference Nutting CM, Morden JP, Harrington KJ, Urbano TG, Bhide SA, Clark C, Miles EA, Miah AB, Newbold K, Tanay M, Adab F, Jefferies SJ, Scrase C, Yap BK, A’Hern RP, Sydenham MA, Emson M, Hall E, PARSPORT trial management group (2011) Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol 12:127–136CrossRefPubMedCentralPubMed Nutting CM, Morden JP, Harrington KJ, Urbano TG, Bhide SA, Clark C, Miles EA, Miah AB, Newbold K, Tanay M, Adab F, Jefferies SJ, Scrase C, Yap BK, A’Hern RP, Sydenham MA, Emson M, Hall E, PARSPORT trial management group (2011) Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol 12:127–136CrossRefPubMedCentralPubMed
21.
go back to reference So WK, Chan RJ, Chan DN, Hughes BG, Chair SY, Choi KC, Chan CW (2012) Quality-of-life among head and neck cancer survivors at one year after treatment—a systematic review. Eur J Cancer:48:2391–2408CrossRefPubMed So WK, Chan RJ, Chan DN, Hughes BG, Chair SY, Choi KC, Chan CW (2012) Quality-of-life among head and neck cancer survivors at one year after treatment—a systematic review. Eur J Cancer:48:2391–2408CrossRefPubMed
22.
go back to reference Abendstein H, Nordgren M, Boysen M, Jannert M, Silander E, Ahlner-Elmqvist M, Hammerlid E, Bjordal K (2005) Quality of life and head and neck cancer: a 5 year prospective study. Laryngoscope 115:2183–2192CrossRefPubMed Abendstein H, Nordgren M, Boysen M, Jannert M, Silander E, Ahlner-Elmqvist M, Hammerlid E, Bjordal K (2005) Quality of life and head and neck cancer: a 5 year prospective study. Laryngoscope 115:2183–2192CrossRefPubMed
23.
go back to reference Nordgren M, Hammerlid E, Bjordal K, Ahlner-Elmqvist M, Boysen M, Jannert M (2008) Quality of life in oral carcinoma: a 5-year prospective study. Head Neck 30:461–470CrossRefPubMed Nordgren M, Hammerlid E, Bjordal K, Ahlner-Elmqvist M, Boysen M, Jannert M (2008) Quality of life in oral carcinoma: a 5-year prospective study. Head Neck 30:461–470CrossRefPubMed
24.
go back to reference Oskam IM, Verdonck-de Leeuw IM, Aaronson NK, Witte BI, de Bree R, Doornaert P, Langendijk JA, Leemans CR (2013) Prospective evaluation of health-related quality of life in long-term oral and oropharyngeal cancer survivors and the perceived need for supportive care. Oral Oncol 49:443–448CrossRefPubMed Oskam IM, Verdonck-de Leeuw IM, Aaronson NK, Witte BI, de Bree R, Doornaert P, Langendijk JA, Leemans CR (2013) Prospective evaluation of health-related quality of life in long-term oral and oropharyngeal cancer survivors and the perceived need for supportive care. Oral Oncol 49:443–448CrossRefPubMed
25.
go back to reference Lin A, Kim HM, Terrell JE, Dawson LA, Ship JA, Eisbruch A (2003) Quality of life after parotid-sparing IMRT for head-and-neck cancer: a prospective longitudinal study. Int J Radiat Oncol Biol Phys 57:61–70CrossRefPubMed Lin A, Kim HM, Terrell JE, Dawson LA, Ship JA, Eisbruch A (2003) Quality of life after parotid-sparing IMRT for head-and-neck cancer: a prospective longitudinal study. Int J Radiat Oncol Biol Phys 57:61–70CrossRefPubMed
26.
go back to reference Maurer J, Hipp M, Schäfer C, Kölbl O (2011) Dysphagia. Impact on quality of life after radio(chemo)therapy of head and neck cancer. Strahlenther Onkol 187:744–749CrossRefPubMed Maurer J, Hipp M, Schäfer C, Kölbl O (2011) Dysphagia. Impact on quality of life after radio(chemo)therapy of head and neck cancer. Strahlenther Onkol 187:744–749CrossRefPubMed
27.
go back to reference Hunter KU, Schipper M, Feng FY, Lyden T, Haxer M, Murdoch-Kinch CA, Cornwall B, Lee CS, Chepeha DB, Eisbruch A (2013) Toxicities affecting quality of life after chemo-IMRT of oropharyngeal cancer: prospective study of patient-reported, observer-rated, and objective outcomes. Int J Radiat Oncol Biol Phys 85:935–940CrossRefPubMedCentralPubMed Hunter KU, Schipper M, Feng FY, Lyden T, Haxer M, Murdoch-Kinch CA, Cornwall B, Lee CS, Chepeha DB, Eisbruch A (2013) Toxicities affecting quality of life after chemo-IMRT of oropharyngeal cancer: prospective study of patient-reported, observer-rated, and objective outcomes. Int J Radiat Oncol Biol Phys 85:935–940CrossRefPubMedCentralPubMed
28.
go back to reference Ringash J, Warde P, Lockwood G, O’Sullivan B, Waldron J, Cummings B (2005) Postradiotherapy quality of life for head-and-neck cancer patients is independent of xerostomia. Int J Radiat Oncol Biol Phys 61:1403–1407CrossRefPubMed Ringash J, Warde P, Lockwood G, O’Sullivan B, Waldron J, Cummings B (2005) Postradiotherapy quality of life for head-and-neck cancer patients is independent of xerostomia. Int J Radiat Oncol Biol Phys 61:1403–1407CrossRefPubMed
29.
go back to reference Morton RP (2003) Studies in the quality of life of head and neck cancer patients: results of a two-year longitudinal study and a comparative cross-sectional cross-cultural survey. Laryngoscope 113:1091–1103CrossRefPubMed Morton RP (2003) Studies in the quality of life of head and neck cancer patients: results of a two-year longitudinal study and a comparative cross-sectional cross-cultural survey. Laryngoscope 113:1091–1103CrossRefPubMed
30.
go back to reference Voordeckers M, Everaert H, Tournel K, Verellen D, Baron I, van Esch G, Vanhove C, Storme G (2007) Longitudinal assessment of parotid function in patients receiving tomotherapy for head and neck cancer. Strahlenther Onkol 184:400–405CrossRef Voordeckers M, Everaert H, Tournel K, Verellen D, Baron I, van Esch G, Vanhove C, Storme G (2007) Longitudinal assessment of parotid function in patients receiving tomotherapy for head and neck cancer. Strahlenther Onkol 184:400–405CrossRef
31.
go back to reference Little M, Schipper M, Feng FY, Vineberg K, Cornwall C, Murdoch-Kinch CA, Eisbruch A (2012) Reducing xerostomia after chemo-IMRT for head-and-neck cancer: beyond sparing the parotid glands. Int J Radiat Oncol Biol Phys 83:1007–1014CrossRefPubMedCentralPubMed Little M, Schipper M, Feng FY, Vineberg K, Cornwall C, Murdoch-Kinch CA, Eisbruch A (2012) Reducing xerostomia after chemo-IMRT for head-and-neck cancer: beyond sparing the parotid glands. Int J Radiat Oncol Biol Phys 83:1007–1014CrossRefPubMedCentralPubMed
32.
go back to reference Jha N, Harris J, Seikaly H, Jacobs JR, McEwan AJ, Robbins KT, Grecula J, Sharma AK, Ang KK (2012) A phase II study of submandibular gland transfer prior to radiation for prevention of radiation-induced xerostomia in head-and-neck cancer (RTOG 0244). Int J Radiat Oncol Biol Phys 84:437–442CrossRefPubMed Jha N, Harris J, Seikaly H, Jacobs JR, McEwan AJ, Robbins KT, Grecula J, Sharma AK, Ang KK (2012) A phase II study of submandibular gland transfer prior to radiation for prevention of radiation-induced xerostomia in head-and-neck cancer (RTOG 0244). Int J Radiat Oncol Biol Phys 84:437–442CrossRefPubMed
33.
go back to reference Wasserman TH, Brizel DM, Henke M, Monnier A, Eschwege F, Sauer R, Strnad V (2005) Influence of intravenous amifostine on xerostomia, tumor control, and survival after radiotherapy for head-and-neck cancer: 2-year follow-up of a prospective, randomized, phase III trial. Int J Radiat Oncol Biol Phys 63:985–990CrossRefPubMed Wasserman TH, Brizel DM, Henke M, Monnier A, Eschwege F, Sauer R, Strnad V (2005) Influence of intravenous amifostine on xerostomia, tumor control, and survival after radiotherapy for head-and-neck cancer: 2-year follow-up of a prospective, randomized, phase III trial. Int J Radiat Oncol Biol Phys 63:985–990CrossRefPubMed
34.
go back to reference Nyarady Z, Nemeth A, Ban A, Mukics A, Nyarady J, Ember I, Olasz L (2006) A randomized study to assess the effectiveness of orally administered pilocarpine during and after radiotherapy of head and neck cancer. Anticancer Res 26:1557–1562PubMed Nyarady Z, Nemeth A, Ban A, Mukics A, Nyarady J, Ember I, Olasz L (2006) A randomized study to assess the effectiveness of orally administered pilocarpine during and after radiotherapy of head and neck cancer. Anticancer Res 26:1557–1562PubMed
35.
go back to reference Simcock R, Fallowfield L, Monson K, Solis-Trapala I, Parlour L, Langridge C, Jenkins V, ARIX Steering Committee (2013) ARIX: a randomised trial of acupuncture v oral care sessions in patients with chronic xerostomia following treatment of head and neck cancer. Ann Oncol 24:776–783CrossRefPubMed Simcock R, Fallowfield L, Monson K, Solis-Trapala I, Parlour L, Langridge C, Jenkins V, ARIX Steering Committee (2013) ARIX: a randomised trial of acupuncture v oral care sessions in patients with chronic xerostomia following treatment of head and neck cancer. Ann Oncol 24:776–783CrossRefPubMed
36.
go back to reference Meng Z, Kay Garcia M, Hu C, Chiang J, Chambers M, Rosenthal DI, Peng H, Wu C, Zhao Q, Zhao G, Liu L, Spelman A, Lynn Palmer J, Wei Q, Cohen L (2012) Sham-controlled, randomised, feasibility trial of acupuncture for prevention of radiation-induced xerostomia among patients with nasopharyngeal carcinoma. Eur J Cancer 48:1692–1699CrossRefPubMed Meng Z, Kay Garcia M, Hu C, Chiang J, Chambers M, Rosenthal DI, Peng H, Wu C, Zhao Q, Zhao G, Liu L, Spelman A, Lynn Palmer J, Wei Q, Cohen L (2012) Sham-controlled, randomised, feasibility trial of acupuncture for prevention of radiation-induced xerostomia among patients with nasopharyngeal carcinoma. Eur J Cancer 48:1692–1699CrossRefPubMed
37.
go back to reference Furness S, Bryan G, McMillan R, Birchenough S, Worthington HV (2013) Interventions for the management of dry mouth: non-pharmacological interventions. Cochrane Database Syst Rev 8:CD009603PubMed Furness S, Bryan G, McMillan R, Birchenough S, Worthington HV (2013) Interventions for the management of dry mouth: non-pharmacological interventions. Cochrane Database Syst Rev 8:CD009603PubMed
38.
go back to reference Furness S, Worthington HV, Bryan G, Birchenough S, McMillan R (2011) Interventions for the management of dry mouth: topical therapies. Cochrane Database Syst Rev 12:CD008934PubMed Furness S, Worthington HV, Bryan G, Birchenough S, McMillan R (2011) Interventions for the management of dry mouth: topical therapies. Cochrane Database Syst Rev 12:CD008934PubMed
Metadata
Title
Residual deficits in quality of life one year after intensity-modulated radiotherapy for patients with locally advanced head and neck cancer
Results of a prospective study
Authors
PD Dr. med. Silke Tribius
Marieclaire Raguse
Christian Voigt
PD Dr. med. Adrian Münscher
PD. Dr. med. Dr. dent. Alexander Gröbe, PD Dr. med. Dr. dent.
PD Dr. med. Cordula Petersen, Prof. Dr. med.
PD Dr. med. Andreas Krüll
PD Dr. phil. Corinna Bergelt
Prof. Dr. Susanne Singer
Publication date
01-06-2015
Publisher
Springer Berlin Heidelberg
Published in
Strahlentherapie und Onkologie / Issue 6/2015
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-015-0824-4

Other articles of this Issue 6/2015

Strahlentherapie und Onkologie 6/2015 Go to the issue