Purpose: This retrospective cohort study aims to compare the quality of life (QoL) in patients with nasopharyngeal cancer (NPC) treated with intensity-modulated proton therapy (IMPT) versus volumetric modulated arc therapy (VMAT) at different time points. Materials and Methods: We conducted a longitudinal assessment of QoL on 287 newly diagnosed NPC patients (IMPT: 41 and VMAT: 246). We collected outcomes of global QoL, functional QoL, C30 symptoms, and HN35 symptoms from EORTC QLQ-C30 and QLQ-HN35 questionnaires at pre-radiotherapy, during radiotherapy (around 40 Gy), 3 months post radiotherapy, and 12-months post radiotherapy (RT). The generalized estimating equation was utilized to interpret the group effect, originating from inherent group differences; time effect, attributed to RT effects over time; and interaction of the group and time effect. Results: IMPT demonstrated superior mean dose reductions in 12 of the 16 organs at risk compared to VMAT, including a significant (>50%) reduction in the oral cavity and larynx. Both groups exhibited improved scores of global QoL, functional QoL, and C30 symptoms at 12 months post RT compared to the pre-RT status. Regarding global QoL and C30 symptoms, there was no interaction effect of group over time. In contrast, significant interaction effects were observed on functional QoL (p= 0.040) and HN35 symptoms (p= 0.004) during RT, where IMPT created an average of 7.5 points higher functional QoL and 10.7 points lower HN35 symptoms than VMAT. Conclusions: Compared to VMAT, dose reduction attributed to IMPT could translate into better functional QoL and HN35 symptoms, but the effect is time dependent and exclusively observed during the RT phase.
目的：本回顾性队列研究旨在比较接受调强质子治疗（IMPT）与容积旋转调强放疗（VMAT）的鼻咽癌（NPC）患者在不同时间点的生活质量（QoL）。材料与方法：我们对287例新诊断的NPC患者（IMPT组41例，VMAT组246例）进行了QoL的纵向评估。通过欧洲癌症研究与治疗组织生活质量核心问卷（EORTC QLQ-C30）及头颈部特异性模块（QLQ-HN35），在放疗前、放疗期间（约40 Gy时）、放疗后3个月及放疗后12个月收集总体QoL、功能QoL、C30症状及HN35症状的评估结果。采用广义估计方程分析组别效应（源于组间固有差异）、时间效应（源于放疗随时间推移产生的影响）以及组别与时间的交互效应。结果：与VMAT相比，IMPT在16个危及器官中的12个实现了更优的平均剂量降低，其中口腔和喉部的剂量降低尤为显著（>50%）。两组患者在放疗后12个月的总体QoL、功能QoL及C30症状评分均较放疗前有所改善。在总体QoL和C30症状方面，未观察到组别与时间存在交互效应。相比之下，在放疗期间，功能QoL（p=0.040）和HN35症状（p=0.004）存在显著的交互效应：IMPT组的功能QoL评分平均比VMAT组高7.5分，而HN35症状评分平均低10.7分。结论：与VMAT相比，IMPT带来的剂量降低可转化为更好的功能QoL和更轻的HN35症状，但该效应具有时间依赖性，仅在放疗期间显现。
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