Abstract
Objective
To analyze nutritional factors and compliance with dietary recommendations for associations with overall survival (OS) and progression-free survival (PFS) in patients receiving definitive RT for laryngeal and oropharyngeal cancers.
Materials/methods
We identified 352 patients with non-metastatic laryngeal (146) and oropharyngeal (206) cancer treated with definitive RT between 2004 and 2013. Disease and patient characteristics, treatment information, sarcopenia based on muscle areas at L3 level on CT, compliance with the nutritional program, and clinical outcomes data were tabulated. Descriptive statistics, Kaplan-Meier survival analysis, and log rank tests were performed, and Cox regression models were used to examine predictors of OS and PFS.
Results
The median follow-up for the entire cohort was 22.86 months. The actuarial rates for OS were 91, 86, and 73% at years 1, 2, and 5, respectively. Of patients with abdominal CT prior to starting RT, 70.9% (112/158) were sarcopenic with a median muscle mass index of 48.2 (range 30.4–70.9) for males and 35.9 (range 24.6–53.2) for females. The majority (85.8%) of patients met with a dietitian during their course of RT and 62.6% of these patients were compliant with the nutritional program. Compliance with the nutritional program resulted in 27% (HR 0.73, 95% CI 0.43–1.26) protection from death (did not reach significance) and 31% (HR 0.69, 95% CI 0.50–0.94) significant protection from disease progression. Higher pretreatment BMI was associated with a lower risk of death (HR 0.94, 95% CI 0.90–0.99) and disease progression (HR 0.96, 95% CI 0.93–0.99).
Conclusion
Laryngeal and oropharyngeal cancer patients treated with definitive RT who are compliant with regular dietetic counseling and contact appear to have improved outcomes.
Trial registration
Not applicable
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Abbreviations
- AND:
-
Academy of Nutrition and Dietetics
- ASPEN:
-
American Society for Parenteral and Enteral Nutrition
- BSA:
-
body surface area
- OS:
-
overall survival
- PFS:
-
progression-free survival
- QOL:
-
quality of life
- RT:
-
radiation therapy
References
Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108
Tarver T (2012) American Cancer Society (ACS) Atlanta, GA: American Cancer Society, 2012. 66 p., pdf. Available from. Journal of Consumer Health on the Internet 2012;16:366–67
Alshadwi A, Nadershah M, Carlson ER, Young LS, Burke PA, Daley BJ (2013) Nutritional considerations for head and neck cancer patients: a review of the literature. J Oral Maxillofac Surg 71:1853–1860
Rabinovitch R, Grant B, Berkey BA, Raben D, Ang KK, Fu KK, Cooper JS, for the Radiation Therapy Oncology Group (2006) Impact of nutrition support on treatment outcome in patients with locally advanced head and neck squamous cell cancer treated with definitive radiotherapy: a secondary analysis of RTOG trial 90-03. Head Neck 28:287–296
Platek ME, Reid ME, Wilding GE, Jaggernauth W, Rigual NR, Hicks WL Jr, Popat SR, Warren GW, Sullivan M, Thorstad WL, Khan MK, Loree TR, Singh AK (2011) Pretreatment nutritional status and locoregional failure of patients with head and neck cancer undergoing definitive concurrent chemoradiation therapy. Head Neck 33:1561–1568
Shachar SS, Williams GR, Muss HB, Nishijima TF (2016) Prognostic value of sarcopenia in adults with solid tumours: a meta-analysis and systematic review. Eur J Cancer 57:58–67
Lesser MLN, Bergerson S, Truillo E (2013) Oncology nutrition for clinical practice. Oncology Nutrition Dietetic Practice Group of the Academy of Nutrition and Dietetics
Care NCCfA (2006) Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition. National Collaborating Centre for Acute Care (UK)
Unsal D, Mentes B, Akmansu M, Uner A, Oguz M, Pak Y (2006) Evaluation of nutritional status in cancer patients receiving radiotherapy: a prospective study. Am J Clin Oncol 29:183–188
Paccagnella A, Morello M, Da Mosto MC et al (2010) Early nutritional intervention improves treatment tolerance and outcomes in head and neck cancer patients undergoing concurrent chemoradiotherapy. Support Care Cancer 18:837–845
Ravasco P, Monteiro-Grillo I, Marques Vidal P, Camilo ME (2005) Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck 27:659–668
Bossola M (2015) Nutritional interventions in head and neck cancer patients undergoing chemoradiotherapy: a narrative review. Nutrients 7:265–276
Langius JA, Zandbergen MC, Eerenstein SE et al (2013) Effect of nutritional interventions on nutritional status, quality of life and mortality in patients with head and neck cancer receiving (chemo)radiotherapy: a systematic review. Clin Nutr 32:671–678
Nugent B, Lewis S, O'Sullivan JM (2013) Enteral feeding methods for nutritional management in patients with head and neck cancers being treated with radiotherapy and/or chemotherapy. Cochrane Database Syst Rev:CD007904
Antoun S, Baracos V, Birdsell L et al (2010) Low body mass index and sarcopenia associated with dose-limiting toxicity of sorafenib in patients with renal cell carcinoma. Ann Oncol:mdp605
Prado CM, Baracos VE, McCargar LJ et al (2009) Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment. Clin Cancer Res 15:2920–2926
Prado CM, Lieffers JR, McCargar LJ et al (2008) Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol 9:629–635
Jager-Wittenaar H, Dijkstra PU, Vissink A, van der Laan BFAM, van Oort RP, Roodenburg JLN (2011) Malnutrition and quality of life in patients treated for oral or oropharyngeal cancer. Head Neck 33:490–496
Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, Bandera EV, Hamilton KK, Grant B, McCullough M, Byers T, Gansler T (2012) Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 62:243–274
Platek ME, McCloskey SA, Cruz M et al (2013) Quantification of the effect of treatment duration on local-regional failure after definitive concurrent chemotherapy and intensity-modulated radiation therapy for squamous cell carcinoma of the head and neck. Head Neck 35:684–688
Platek ME (2012) The role of dietary counseling and nutrition support in head and neck cancer patients. Curr Opin Support Palliat Care 6:438–445
Mick R, Vokes EE, Weichselbaum RR, Panje WR (1991) Prognostic factors in advanced head and neck cancer patients undergoing multimodality therapy. Otolaryngol Head Neck Surg 105:62–73
Ottosson S, Soderstrom K, Kjellen E et al (2014) Weight and body mass index in relation to irradiated volume and to overall survival in patients with oropharyngeal cancer: a retrospective cohort study. Radiat Oncol 9:160
Funding
Funding was provided by the Department of Radiation Oncology at Montefiore Medical Center.
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RK, SK, and MG conceived the study, participated in its design and coordination, and helped to draft the manuscript.
AB and MR participated in the study execution.
KPM and AA participated in the data collection.
SV performed the statistical analysis.
All authors read and approved the final manuscript.
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This retrospective review was approved by the IRB at the Albert Einstein College of Medicine.
Conflict of interest
The authors declare that they have no competing interests.
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Kabarriti, R., Bontempo, A., Romano, M. et al. The impact of dietary regimen compliance on outcomes for HNSCC patients treated with radiation therapy. Support Care Cancer 26, 3307–3313 (2018). https://doi.org/10.1007/s00520-018-4198-x
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DOI: https://doi.org/10.1007/s00520-018-4198-x