Burden of acute toxicities in head-and-neck radiation therapy: A single-institutional experience

Abstract

Introduction: Combined modality therapy is the standard of care in locally advanced head-and-neck cancer (HNC). The incidence of acute toxicities increases with additional therapy. The present study investigated the incidence and patterns of mucositis, dysphagia, aspiration, feeding tube use, admission for supportive care, and treatment compliance in patients with HNC treated curatively with radiation therapy (RT) with or without chemotherapy. Methods and Material: A retrospective review of 164 consecutive HNC patients treated with RT at St. John's Medical College Hospital, Bengaluru, from January 2013 to June 2017 was done. Results: A total of 148 HNC patients were treated with a curative intent and 122 (82.4%) were locally advanced HNC. Combined Modality treatment was received by 119 (80.4%) patients. Eighty-four (56.7%) patients were treated by concurrent chemo-radiation. IMRT technique was used in 125 (84.5%) patients. The incidence of grade 3-4 mucositis, dysphagia and aspiration was 25%, 46%, and 10%, respectively. Nasogastric tube feeding was necessitated in 18.9% (n=28) and 27% (n = 40) required inpatient admission for supportive care. Twenty-nine (19.6%) patients did not complete planned RT dose and 46 (31%) patients had unscheduled RT break (>2days). Fifty-six (66.7%) patients did not receive planned chemotherapy. Conclusions: Acute toxicity due to RT in HNC remains a challenge despite using modern techniques. A significant proportion of patients require supportive therapy for more than 12 weeks and did not complete the scheduled treatment.

Aconselhamento Nutricional em Pacientes com Câncer de Cabeça, Pescoço e Esôfago em Tratamento (Quimio)Radioterápico

“…Esse resultado pode sugerir que, após a terceira semana de radioterapia, o paciente fica mais suscetível à queda no estado nutricional em decorrência do agravo dos sintomas, o que pode também ser consequência da toxicidade causada pelo tratamento. Assemelhando-se a esses resultados, um estudo retrospectivo realizado na Índia com pacientes de cabeça e pescoço em tratamento radioterápico mostrou que os indivíduos desenvolveram mucosite e disfagia a partir da terceira semana do tratamento 30 . Pan et al 31 avaliaram o estado nutricional de pacientes com câncer de esôfago em quimiorradioterapia e encontraram prevalência de 83% de desnutrição, sugerindo, com esses resultados, a implementação da intervenção nutricional no setor de radioterapia 31 .…”

Identifying Patient-Reported Outcome Measures (PROMs) for Routine Surveillance of Physical and Emotional Symptoms in Head and Neck Cancer Populations: A Systematic Review

“…The University of Washington Quality of Life (UW-QOL) questionnaire swallowing subscale [42,63,65,71], the M.D. Anderson Dysphagia Inventory (MDADI) [41,62,68,125], and the Common Terminology Criteria for Adverse Event [74,[77][78][79][80][81] were the most commonly used instruments to assess dysphagia. Jager-Wittenaar et al reported that approximately 28% of patients (oral, pharynx, and larynx) experienced dysphagia at diagnosis, likely as a result of the disease itself [60].…”

“…The prevalence of decreased appetite was reported among 10 studies [5,30,38,40,41,45,58,69,73,81]. Bond et al reported that, overall, 96% of their patients reported trouble with appetite [30].…”

“…Loss of appetite, loss of taste, and dysphagia are significantly associated with critical weight loss [60]. Sixteen studies reported malnutrition (clinician reported) and weight loss, with prevalence ranging between 3% and 95% [5,34,35,45,56,58,60,62,70,73,81,[102][103][104][105][106]. Most studies defined critical weight loss as involuntary loss of more than 5% of normal weight within the past 1 to 6 months [34,56,58,60,62,[102][103][104].…”

“…Prevalence of oral mucositis, typically described by patients as presence of mouth or throat sores, was reported in 15 studies, ranging from 44% and 68% prior to treatment [73,74,[77][78][79][80][81]88,[107][108][109][110][111][112][113]. Elting et al reported that patients who received chemotherapy had higher prevalence than those without [108].…”