Supportive Care in Cancer

, Volume 18, Issue 6, pp 667–677

Nutritional support for head and neck cancer patients receiving radiotherapy: a systematic review

Original Article



Squamous cell carcinoma of the head and neck (HNSCC) is associated with weight loss before, during, and after treatment with radiotherapy (RT). This systematic review addressed the question “Which interventions aimed at optimizing nutrition are of benefit to HNSCC patients receiving RT?”


Randomized controlled trials (RCTs) studying interventions directed at nutritional support of adult patients with HNSCC receiving RT with or without chemotherapy were eligible. RCTs studying prophylaxis of acute mucositis, perioperative nutrition, or palliative and non-HNSCC populations were excluded. A comprehensive literature search was done and meta-analyses planned.


Ten unique RCTs were identified (n = 585). All randomized less than 50 patients per trial arm. Five trials studied dietary counseling and/or nutritional supplements, four studied drug interventions, and one studied prophylactic enteral tube feeding. Nutritional status appeared to be maintained or improved with dietary counseling, megestrol acetate, and prophylactic enteral tube feeding.


Data from RCTs supporting the use of interventions to optimize nutrition in HNSCC patients receiving RT are limited in both quantity and quality. Potentially effective interventions have not been tested comparatively or in combination, and few patients receiving chemoradiotherapy were studied. Further research in this area is a priority.


Nutrition Radiotherapy Head and neck neoplasms Megestrol acetate Enteral feeding 


  1. 1.
    Chin D, Boyle GM, Porceddu S, Theile DR, Parsons PG, Coman WB (2006) Head and neck cancer: past, present and future. Expert Rev Anticancer Ther 6(7):1111–1118CrossRefPubMedGoogle Scholar
  2. 2.
    Lees J (1999) Incidence of weight loss in head and neck cancer patients on commencing radiotherapy treatment at a regional oncology centre. Eur J Cancer Care 8:133–136CrossRefGoogle Scholar
  3. 3.
    Winquist E, Oliver T, Gilbert R (2007) Postoperative chemoradiotherapy for advanced squamous cell carcinoma of the head and neck: a systematic review with meta-analysis. Head Neck 29(1):38–46CrossRefPubMedGoogle Scholar
  4. 4.
    El-Sayed S, Nabid A, Shelley W, Hay J, Balogh J, Gelinas M et al (2002) Prophylaxis of radiation-associated mucositis in conventionally treated patients with head and neck cancer: a double-blind, phase III, randomized, controlled trial evaluating the clinical efficacy of an antimicrobial lozenge using a validated mucositis scoring system. J Clin Oncol 20:3956–3963CrossRefPubMedGoogle Scholar
  5. 5.
    Nitenberg G, Raynard B (2000) Nutritional support of the cancer patient: issues and dilemmas. Crit Rev Oncol Hematol 34:137–168CrossRefPubMedGoogle Scholar
  6. 6.
    Stokman MA, Spijkervet FK, Boezen HM, Schouten JP, Roodenburg JL, de Vries EG (2006) Preventive intervention possibilities in radiotherapy- and chemotherapy-induced oral mucositis: results of meta-analyses. J Dent Res 85(8):690–700CrossRefPubMedGoogle Scholar
  7. 7.
    Scottish Intercollegiate Guideline Network (2006) Diagnosis and management of head and neck cancer: a national clinical guideline: pp 50-51. Accessed 23 April 2009
  8. 8.
    Arnold C, Richter MP (1989) The effect of oral nutritional supplements on head and neck cancer. Int J Radiat Oncol Biol Phys 16:1595–1599PubMedGoogle Scholar
  9. 9.
    Nayel H, El-Ghoneimy E, El-Haddad S (1992) Impact of nutritional supplementation on treatment delay and morbidity in patients with head and neck tumors treated with irradiation. Nutrition 8:13–18PubMedGoogle Scholar
  10. 10.
    Lovik A, Almendingen K, Dotterud M, Forli L, Boysen M, Omarhus M et al (1996) Dietary information after radiotherapy of head and neck cancer. Tidsskr Nor Laegeforen 116(19):2303–2306 NorwegianPubMedGoogle Scholar
  11. 11.
    Isenring EA, Capra S, Bauer JD (2001) Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. Br J Cancer 91:447–452CrossRefGoogle Scholar
  12. 12.
    Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME (2005) Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck 27(8):659–668CrossRefPubMedGoogle Scholar
  13. 13.
    Fietkau R, Riepl M, Kettner H, Hinke A, Sauer R (1997) Supportive use of megestrol acetate in patients with head and neck cancer during radio(chemo)therapy. Eur J Cancer 33:75–79CrossRefPubMedGoogle Scholar
  14. 14.
    Chen HC, Leung SW, Wang CJ, Sun LM, Fang FM, Hsu JH (1997) Effect of megestrol acetate and prepulsid on nutritional improvement in patients with head and neck cancers undergoing radiotherapy. Radiother Oncol 43:75–79CrossRefPubMedGoogle Scholar
  15. 15.
    McQuellon RP, Moose DB, Russell GB, Case LD, Greven K, Stevens M et al (2002) Supportive use of megestrol acetate (Megace) with head/neck and lung cancer patients receiving radiation therapy. Int J Radiat Oncol Biol Phys 52(5):1180–1185CrossRefPubMedGoogle Scholar
  16. 16.
    Farmer M, Case D, Lesser G, Monitto D, Smathers S, May B et al (2005) A phase III, double blind, placebo-controlled, prospective randomized trial on the effect of megestrol acetate on weight and health related quality of life in lung cancer and head and neck cancer patients receiving curative radiation therapy. Int J Radiat Oncol Biol Phys 63:S77–S78Google Scholar
  17. 17.
    Daly JM, Hearne B, Dunaj J, LePorte B, Vikram B, Strong E et al (1984) Nutritional rehabilitation in patients with advanced head and neck cancer receiving radiation therapy. Am J Surg 148:514–520CrossRefPubMedGoogle Scholar
  18. 18.
    Ottery F (1996) Definition of standardized nutritional assessment and interventional pathways in oncology. Nutrition 12:s15–s19PubMedGoogle Scholar
  19. 19.
    Isenring EA, Bauer JD, Capra S (2007) Nutrition support using the American Dietetic Association medical nutrition therapy protocol for radiation oncology patients improves dietary intake compared with standard practice. J Am Diet Assoc 107(3):404–412CrossRefPubMedGoogle Scholar
  20. 20.
    Berenstein EG, Ortiz Z (2005) Megestrol acetate for the treatment of anorexia-cachexia syndrome. Cochrane Database Syst Rev [2]:CD004310Google Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Schulich School of Medicine and DentistryUniversity of Western OntarioLondonCanada
  2. 2.Department of Otolaryngology - Head and Neck SurgeryUniversity of Western OntarioLondonCanada
  3. 3.Department of OncologyUniversity of Western OntarioLondonCanada
  4. 4.London Health Sciences CentreLondonCanada

Personalised recommendations