A Prospective Evaluation of Health-Related Patient-Reported Outcomes after Skull Base Reirradiation

Purpose: To report health-related patient-reported outcomes (HR-PRO) after highly conformal re-irradiation (re-RT) of the skull base.

Methods: Patients planned for curative intent re-RT to a recurrent or new primary tumor of the skull base were prospectively enrolled between 2014 and 2017. HR-PRO were assessed at baseline, at end of treatment (EoT), and at 3, 6, 9 and 12 months after RT using the MD Anderson Symptom Inventory Brain Tumor (MDASI-BT) and the anterior skull base surgery QoL (ASBQ) questionnaires. HR-PRO measures were analyzed using linear mixed models. Kaplan–Meier analysis was used for secondary outcomes of local control and progression free survival (PFS).

Results: Thirty-nine patients with a median age of 58 years (range = 33–85) were enrolled. Fifty percent of patients had surgical resection at the time of recurrence. Fifty percent of patients had concurrent systemic therapy and 25% had induction chemotherapy. Median interval between previous radiotherapy and re-RT was 27 months (range = 4–491). Sites of recurrence were anterior and central skull base (49%), nasopharynx and retropharynx (25%), lateral skull base (23%) and sinonasal cavity (13%). Sixty percent of patients were treated with conventionally fractionated IMRT or proton beam therapy and 40% were treated with SBRT. Median follow-up was 14 months (range = 2–36 months). At end of treatment, there was mild worsening of the symptoms of fatigue, lack of appetite and drowsiness (MDASI-BT), and mild worsening of the domains of vitality and physical function (ASBQ). This was followed by rapid recovery to baseline values at all subsequent follow-up. The domain of emotions (ASBQ) was improved at 12 months compared with baseline, with patients reporting feeling less tense/nervous at EoT compared with baseline, and less worried at 12 months compared with baseline.

Conclusion: Skull base re-RT is associated with minimal, immediate post-RT deterioration in specific symptoms and physical function, which returned to baseline at first follow-up. There was improvement in emotional domain posttreatment. Overall, this study shows excellent tolerance by patients to highly conformal skull base re-RT.

No conflict of interest has been declared by the author(s).