{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T17:14:14Z","timestamp":1792689254176,"version":"4.5.0"},"reference-count":40,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T00:00:00Z","timestamp":1710892800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Chang Gung Memorial Hospital","award":["CMRPG8J1031-3"],"award-info":[{"award-number":["CMRPG8J1031-3"]}]},{"name":"Chang Gung Memorial Hospital","award":["CMRPG8N0971"],"award-info":[{"award-number":["CMRPG8N0971"]}]},{"name":"Chang Gung Memorial Hospital","award":["KMU-TC113A01"],"award-info":[{"award-number":["KMU-TC113A01"]}]},{"name":"Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan","award":["CMRPG8J1031-3"],"award-info":[{"award-number":["CMRPG8J1031-3"]}]},{"name":"Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan","award":["CMRPG8N0971"],"award-info":[{"award-number":["CMRPG8N0971"]}]},{"name":"Research Center for Precision Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan","award":["KMU-TC113A01"],"award-info":[{"award-number":["KMU-TC113A01"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>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 (&gt;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.<\/jats:p>","DOI":"10.3390\/cancers16061217","type":"journal-article","created":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T05:04:12Z","timestamp":1710911052000},"page":"1217","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Longitudinal Assessment of Quality of Life in Nasopharyngeal Cancer Patients Treated with Intensity-Modulated Proton Therapy and Volumetric Modulated Arc Therapy at Different Time Points"],"prefix":"10.3390","volume":"16","author":[{"given":"Kuan-Cho","family":"Liao","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology, Kaohsiung Chang-Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833401, Taiwan"},{"name":"Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung 807378, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5729-3305","authenticated-orcid":false,"given":"Yu-Jie","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Kaohsiung Chang-Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833401, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Ling","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Cosmetics and Fashion Styling, Center for Environmental Toxin and Emerging-Contaminant Research, Cheng Shiu University, Kaohsiung 833301, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0988-264X","authenticated-orcid":false,"given":"Chien-Hung","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung 807378, Taiwan"},{"name":"Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807378, Taiwan"},{"name":"Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807378, Taiwan"},{"name":"Office of Institutional Research & Planning, Secretariat, Kaohsiung Medical University, Kaohsiung 807378, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fu-Min","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Kaohsiung Chang-Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833401, Taiwan"},{"name":"Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 333323, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,3,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/j.radonc.2011.11.017","article-title":"Volumetric modulated arc therapy for nasopharyngeal carcinoma: A dosimetric comparison with TomoTherapy and step-and-shoot IMRT","volume":"104","author":"Lu","year":"2012","journal-title":"Radiother. Oncol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"119","DOI":"10.14338\/IJPT-20-00082.1","article-title":"A Systematic Review of Proton Therapy for the Management of Nasopharyngeal Cancer","volume":"8","author":"Lee","year":"2021","journal-title":"Int. J. Part. Ther."},{"key":"ref_3","first-page":"2236","article-title":"Overview of health-related quality-of-life measures","volume":"49","author":"MacKeigan","year":"1992","journal-title":"Am. J. Hosp. Pharm."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"E2130","DOI":"10.1002\/hed.23977","article-title":"Evidence on effectiveness of intensity-modulated radiotherapy versus 2-dimensional radiotherapy in the treatment of nasopharyngeal carcinoma: Meta-analysis and a systematic review of the literature","volume":"38","author":"Co","year":"2016","journal-title":"Head Neck"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1186\/s13014-020-01532-4","article-title":"Quality of life and survival outcome for patients with nasopharyngeal carcinoma treated by volumetric-modulated arc therapy versus intensity-modulated radiotherapy","volume":"15","author":"Huang","year":"2020","journal-title":"Radiat. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1016\/j.ijrobp.2006.06.013","article-title":"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","volume":"66","author":"Pow","year":"2006","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1016\/j.oraloncology.2015.08.005","article-title":"Intensity-modulated radiation therapy versus 2D-RT or 3D-CRT for the treatment of nasopharyngeal carcinoma: A systematic review and meta-analysis","volume":"51","author":"Zhang","year":"2015","journal-title":"Oral. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1093\/jnci\/djx208","article-title":"Quality of Life and Patient-Reported Outcomes Following Proton Radiation Therapy: A Systematic Review","volume":"110","author":"Verma","year":"2018","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1007\/s00405-020-06175-5","article-title":"Proton pencil-beam scanning radiotherapy in the treatment of nasopharyngeal cancer: Dosimetric parameters and 2-year results","volume":"278","author":"Michal","year":"2021","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"28","DOI":"10.14338\/IJPT-20-00057.1","article-title":"Intensity-Modulated Proton Therapy for Nasopharynx Cancer: 2-year Outcomes from a Single Institution","volume":"8","author":"Williams","year":"2021","journal-title":"Int. J. Part. Ther."},{"key":"ref_11","first-page":"41","article-title":"Particle beam therapy for nasopharyngeal cancer: A systematic review and meta-analysis","volume":"37","author":"Ng","year":"2022","journal-title":"Clin. Transl. Radiat. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Chou, Y.C., Fan, K.H., Lin, C.Y., Hung, T.M., Huang, B.S., Chang, K.P., Kang, C.J., Huang, S.F., Chang, P.H., and Hsu, C.L. (2021). Intensity Modulated Proton Beam Therapy versus Volumetric Modulated Arc Therapy for Patients with Nasopharyngeal Cancer: A Propensity Score-Matched Study. Cancers, 13.","DOI":"10.3390\/cancers13143555"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e2113205","DOI":"10.1001\/jamanetworkopen.2021.13205","article-title":"Toxicity Profiles and Survival Outcomes among Patients with Nonmetastatic Nasopharyngeal Carcinoma Treated with Intensity-Modulated Proton Therapy vs. Intensity-Modulated Radiation Therapy","volume":"4","author":"Li","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3587","DOI":"10.1120\/jacmp.v12i4.3587","article-title":"Comparative analysis of SmartArc-based dual arc volumetric-modulated arc radiotherapy (VMAT) versus intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma","volume":"12","author":"Lee","year":"2011","journal-title":"J. Appl. Clin. Med. Phys."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Lin, Y.H., Cheng, J.Y., Huang, B.S., Luo, S.D., Lin, W.C., Chou, S.Y., Juang, P.J., Li, S.H., Huang, E.Y., and Wang, Y.M. (2021). Significant Reduction in Vertebral Artery Dose by Intensity Modulated Proton Therapy: A Pilot Study for Nasopharyngeal Carcinoma. J. Pers. Med., 11.","DOI":"10.3390\/jpm11080822"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3684","DOI":"10.1200\/JCO.2008.19.9109","article-title":"Intensity-modulated radiation therapy with or without chemotherapy for nasopharyngeal carcinoma: Radiation therapy oncology group phase II trial 0225","volume":"27","author":"Lee","year":"2009","journal-title":"J. Clin. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1002\/cncr.27853","article-title":"Long-term survival analysis of nasopharyngeal carcinoma by plasma Epstein-Barr virus DNA levels","volume":"119","author":"Wang","year":"2013","journal-title":"Cancer"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.1056\/NEJMoa1905287","article-title":"Gemcitabine and Cisplatin Induction Chemotherapy in Nasopharyngeal Carcinoma","volume":"381","author":"Zhang","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1023\/A:1022070220328","article-title":"Quality of life in patients of nasopharyngeal carcinoma: Validation of the Taiwan Chinese version of the EORTC QLQ-C30 and the EORTC QLQ-H&N35","volume":"12","author":"Chie","year":"2003","journal-title":"Qual. Life Res."},{"key":"ref_20","unstructured":"Fayers, P., Aaronson, N.K., Bjordal, K., Groenvold, M., Curran, D., and Bottomley, A. (2001). EORTC QLQ-C30 Scoring Manual, European Organisation for Research and Treatment of Cancer. [3rd ed.]."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1839","DOI":"10.1017\/S136898001400281X","article-title":"BMI and all-cause mortality among middle-aged and older adults in Taiwan: A population-based cohort study","volume":"18","author":"Chung","year":"2015","journal-title":"Public Health Nutr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"93","DOI":"10.3322\/caac.21388","article-title":"The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more \u201cpersonalized\u201d approach to cancer staging","volume":"67","author":"Amin","year":"2017","journal-title":"CA Cancer J. Clin."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.jpeds.2015.12.061","article-title":"Fructose-rich beverage intake and central adiposity, uric acid, and pediatric insulin resistance","volume":"171","author":"Lin","year":"2016","journal-title":"J. Pediatr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1002\/(SICI)1097-0258(19980615)17:11<1261::AID-SIM846>3.0.CO;2-Z","article-title":"Extending the simple linear regression model to account for correlated responses: An introduction to generalized estimating equations and multi-level mixed modelling","volume":"17","author":"Burton","year":"1998","journal-title":"Stat. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"E1886","DOI":"10.1002\/hed.24341","article-title":"Intensity-modulated proton therapy for nasopharyngeal carcinoma: Decreased radiation dose to normal structures and encouraging clinical outcomes","volume":"38","author":"Lewis","year":"2016","journal-title":"Head Neck"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1016\/j.ijrobp.2007.12.054","article-title":"Quality of life and survival outcome for patients with nasopharyngeal carcinoma receiving three-dimensional conformal radiotherapy vs. intensity-modulated radiotherapy-a longitudinal study","volume":"72","author":"Fang","year":"2008","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1016\/j.ijrobp.2006.04.033","article-title":"Parotid-sparing intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma: Preserved parotid function after IMRT on quantitative salivary scintigraphy, and comparison with historical data after conventional radiotherapy","volume":"66","author":"Hsiung","year":"2006","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"13165","DOI":"10.1038\/srep13165","article-title":"Patient- and therapy-related factors associated with the incidence of xerostomia in nasopharyngeal carcinoma patients receiving parotid-sparing helical tomotherapy","volume":"5","author":"Lee","year":"2015","journal-title":"Sci. Rep."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1016\/S1470-2045(23)00265-6","article-title":"Dysphagia-optimised intensity-modulated radiotherapy versus standard intensity-modulated radiotherapy in patients with head and neck cancer (DARS): A phase 3, multicentre, randomised, controlled trial","volume":"24","author":"Nutting","year":"2023","journal-title":"Lancet Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1200\/JCO.1998.16.1.139","article-title":"Interpreting the significance of changes in health-related quality-of-life scores","volume":"16","author":"Osoba","year":"1998","journal-title":"J. Clin. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1007\/BF00439229","article-title":"The interpretation of scores from the EORTC quality of life questionnaire QLQ-C30","volume":"5","author":"King","year":"1996","journal-title":"Qual. Life Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1282","DOI":"10.1002\/hed.25551","article-title":"Concurrent chemoradiotherapy by simultaneously integrated boost volumetric-modulated arc therapy for nasopharyngeal carcinoma-toxicity\/quality of life and survival","volume":"41","author":"Fang","year":"2019","journal-title":"Head Neck"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1586\/14737140.2015.961427","article-title":"Outcomes of xerostomia-related quality of life for nasopharyngeal carcinoma treated by IMRT: Based on the EORTC QLQ-C30 and H&N35 questionnaires","volume":"15","author":"Bian","year":"2015","journal-title":"Expert Rev. Anticancer Ther."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1016\/j.ijrobp.2016.02.044","article-title":"Intensity Modulated Proton Therapy Versus Intensity Modulated Photon Radiation Therapy for Oropharyngeal Cancer: First Comparative Results of Patient-Reported Outcomes","volume":"95","author":"Sio","year":"2016","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ijrobp.2008.07.059","article-title":"Intensity-modulated radiotherapy reduces radiation-induced morbidity and improves health-related quality of life: Results of a nonrandomized prospective study using a standardized follow-up program","volume":"74","author":"Vergeer","year":"2009","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/S0895-4356(00)00312-7","article-title":"The association between socioeconomic status, health insurance coverage, and quality of life in men with prostate cancer","volume":"54","author":"Penson","year":"2001","journal-title":"J. Clin. Epidemiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1294","DOI":"10.1002\/(SICI)1097-0142(20000315)88:6<1294::AID-CNCR4>3.0.CO;2-M","article-title":"Quality of life in survivors of colorectal carcinoma","volume":"88","author":"Ramsey","year":"2000","journal-title":"Cancer"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1507","DOI":"10.1016\/S0277-9536(99)00045-3","article-title":"Integrating response shift into health-related quality of life research: A theoretical model","volume":"48","author":"Sprangers","year":"1999","journal-title":"Soc. Sci. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1093\/ageing\/afw107","article-title":"Association of socioeconomic status and cognitive functioning change among elderly Chinese people","volume":"45","author":"Yang","year":"2016","journal-title":"Age Ageing"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1186\/s12939-023-01887-6","article-title":"Relationship between socioeconomic status and cognitive ability among Chinese older adults: The moderating role of social support","volume":"22","author":"Shi","year":"2023","journal-title":"Int. J. Equity Health"}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/6\/1217\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:16:27Z","timestamp":1760105787000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/16\/6\/1217"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,20]]},"references-count":40,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["cancers16061217"],"URL":"https:\/\/doi.org\/10.3390\/cancers16061217","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,20]]}}}