Early nutritional intervention improves treatment tolerance and outcomes in head and neck cancer patients undergoing concurrent chemoradiotherapy
- 2.7k Downloads
Goals of work
Patients with head and neck cancer (HNC) undergoing chemoradiotherapy are at high risk of malnutrition, which is related to complication rate. The aim of this study was to investigate the impact of an early intensive nutritional intervention on nutritional status and outcomes in patients undergoing chemoradiotherapy for HNC.
Materials and methods
We analysed retrospectively the clinical documentation of 33 HNC patients who were referred for early nutritional intervention (nutrition intervention group, NG) before they were submitted to chemoradiotherapy. The outcome of these patients was compared to that of 33 patients who received chemoradiotherapy without receiving a specifically designed early nutrition support programme (control group, CG).
NG patients lost less weight during chemoradiotherapy compared to CG patients (−4.6 ± 4.1% vs −8.1 ± 4.8% of pre-treatment weight, p < 0.01, at the completion of treatment). Patients in the NG experienced fewer radiotherapy breaks (>5 days) for toxicity (30.3% vs 63.6%, p < 0.01); the mean number of days of radiation delayed for toxicity was 4.4 ± 5.2 in NG vs 7.6 ± 6.5 in CG (p < 0.05); a linear correlation was found between percentage of weight lost from baseline to chemoradiotherapy completion and days of radiation delays (p < 0.01). There were less patients who had an unplanned hospitalisation in the NG relative to the CG (16.1% vs 41.4%, p = 0.03). In the NG, symptoms having an effect on the nutritional status developed early and were present in the nearly totality of patients at chemotherapy completion; 60.6% of NG patients needed tube feeding.
Early nutrition intervention in patients with HNC receiving chemoradiotherapy resulted in an improved treatment tolerance and fewer admissions to hospital. This result suggests that nutritional intervention must be initiated before chemoradiotherapy, and it needs to be continued after treatment completion.
KeywordsChemoradiotherapy Enteral nutrition Head and neck cancer Nutrition support
We thank Prof. A. Laviano, M.D. from Department of Clinical Medicine, University La Sapienza, Rome, Italy, for the critical review of the manuscript.
Conflict of interest
The authors declare no conflict of interest.
- 4.Arends J, Bodoky G, Bozzetti F, Fearon K, Muscaritoli M, Selga G, van Bokhorst-de, van der Schueren MA, von Meyenfeldt M, Zürcher G, Fietkau R, Aulbert E, Frick B, Holm M, Kneba M, Mestrom HJ, Zander A, DGEM (German Society for Nutritional Medicine), ESPEN (European Society for Parenteral and Enteral Nutrition) (2006) ESPEN Guidelines on Enteral Nutrition: Non-surgical oncology. Clin Nutr 25:245–259CrossRefPubMedGoogle Scholar
- 10.Capuano G, Grosso A, Gentile PC, Battista M, Bianciardi F, Di Palma A, Pavese I, Satta F, Tosti M, Palladino A, Coiro G, Di Palma M (2008) Influence of weight loss on outcomes in patients with head and neck cancer undergoing concurrent chemoradiotherapy. Head Neck 30:503–508CrossRefPubMedGoogle Scholar
- 15.Cox JD, Pajak TF, Marcial VA, Coia L, Mohiuddin M, Fu KK, Selim HM, Byhardt RW, Rubin P, Ortiz HG et al (1992) Interruptions adversely affect local control and survival with hyperfractionated radiation therapy of carcinomas of the upper respiratory and digestive tracts. New evidence for accelerated proliferation from Radiation Therapy Oncology Group Protocol 8313. Cancer 69:2744–2748CrossRefPubMedGoogle Scholar
- 17.Denis F, Garaud P, Bardet E, Alfonsi M, Sire C, Germain T, Bergerot P, Rhein B, Tortochaux J, Calais G (2004) Final results of the 94-01 French Head and Neck Oncology and Radiotherapy Group randomized trial comparing radiotherapy alone with concurrent radiochemotherapy in advanced-stage oropharynx carcinoma. J Clin Oncol 22:69–76CrossRefPubMedGoogle Scholar
- 18.Dewys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR, Cohen MH, Douglass HO Jr, Engstrom PF, Ezdinli EZ, Horton J, Johnson GJ, Moertel CG, Oken MM, Perlia C, Rosenbaum C, Silverstein MN, Skeel RT, Sponzo RW, Tormey DC (1980) Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med 69:491–497CrossRefPubMedGoogle Scholar
- 20.Fung K, Lyden TH, Lee J, Urba SG, Worden F, Eisbruch A, Tsien C, Bradford CR, Chepeha DB, Hogikyan ND, Prince ME, Teknos TN, Wolf GT (2005) Voice and swallowing outcomes of an organ-preservation trial for advanced laryngeal cancer. Int J Radiat Oncol Biol Phys 63:1395–1399CrossRefPubMedGoogle Scholar
- 33.Machtay M, Rosenthal DI, Hershock D, Jones H, Williamson S, Greenberg MJ, Weinstein GS, Aviles VM, Chalian AA, Weber RS, Penn Cancer Center Clinical Trials Group (2002) Organ preservation therapy using induction plus concurrent chemoradiation for advanced resectable oropharyngeal carcinoma: a University of Pennsylvania Phase II Trial. J Clin Oncol 20:3964–3971CrossRefPubMedGoogle Scholar
- 38.National Cancer Institute (1999) National Cancer Institute Common Toxicity Criteria version 2.0. http://ctep.cancer.gov/protocolDevelopment/
- 41.Odelli C, Burgess D, Bateman L, Hughes A, Ackland S, Gillies J, Collins CE (2005) Nutrition support improves patient outcomes, treatment tolerance and admission characteristics in oesophageal cancer. Clin Oncol (R Coll Radiol) 17:639–645Google Scholar
- 44.Pignon JP, Bourhis J, Domenge C, Designé L (2000) Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet 355:949–955PubMedGoogle Scholar
- 54.Sobin L, Ch W (1997) UICC TNM classification of malignant tumours. Wiley, New YorkGoogle Scholar
- 56.The Royal College of Surgeons of England (2005) Nutrition support in adults: oral supplements, enteral and parenteral feeding. Full guideline DRAFTGoogle Scholar
- 60.Wiggenraad RG, Flierman L, Goossens A, Brand R, Verschuur HP, Croll GA, Moser LE, Vriesendorp R (2007) Prophylactic gastrostomy placement and early tube feeding may limit loss of weight during chemoradiotherapy for advanced head and neck cancer, a preliminary study. Clin Otolaryngol 32:384–390PubMedGoogle Scholar