High Weight Loss during Radiation Treatment Changes the Prognosis in Under-/Normal Weight Nasopharyngeal Carcinoma Patients for the Worse: A Retrospective Analysis of 2433 Cases

Abstract

BackgroundAlthough weight loss is common in nasopharyngeal carcinoma (NPC) patients receiving radiotherapy, the prognostic influence of weight loss and its impact modified by body mass index (BMI) are still unclear.Methods2433 NPC patients receiving radical radiotherapy at Sun Yat-sen University Cancer Center from November, 2000 to December, 2004 were enrolled. Weight change during radiation treatment was categorized into high weight loss (HWL) and low weight loss (LWL). The associations of HWL with overall survival (OS) and disease-specific survival (DSS) were analyzed by Cox regression.ResultsAmong underweight patients, HWL was independently associated with poor OS (hazard ratio [HR], 2.06; 95% CI 1.36–3.11) and DSS (HR, 2.27; 95% CI 1.38–3.73), as compared with LWL, after adjusting for covariates. In normal weight patients, the impact of HWL on OS (HR, 1.47; 95% CI 1.19–1.80) and DSS (HR, 1.59; 95% CI 1.24–2.03) was moderate. Among overweight/obese patients, no significant association between HWL and OS (HR, 1.22; 95% CI 0.95–1.55), or DSS (HR, 1.23; 95% CI 0.93–1.64) was found.ConclusionExcept for overweight/obese patients, high weight loss during radiation treatment was independently associated with poor survival in NPC. This impact was more prominent in the underweight patient group.

Prognostic significance of body mass index before treatment for head and neck cancer

“…If a patient is severely malnourished, the treatment choice should be surgery, not RT or CRT. This is supported by the observation that rapid weight loss during RT is associated with a worse prognosis, and patients with a lower BMI may be more vulnerable to weight loss than those with a higher BMI. However, although poor nutritional status in surgically treated patients increases the risk of complications, it does not affect the oncologic outcome.…”

“…We could not include weight loss as a nutritional parameter because of lack of data. Recently, Shen et al showed that BMI combined with weight change during treatment was superior to BMI alone in predicting the survival of patients with nasopharyngeal cancer. We should therefore include both BMI and weight change in future studies.…”

“…Other similar studies, however, did include patients receiving particular treatments, such as surgery, CRT . and radiation therapy (RT) …”

Benefit of percutaneous endoscopic gastrostomy in patients undergoing definitive chemoradiotherapy for locally advanced nasopharyngeal carcinoma

“…Therefore, it is necessary to maintain weight in cancer patients during the treatment period. Although unplanned weight loss among those not receiving nutrition via prophylactic PEG tubes appeared to be temporary and reversible in the ensuing recovery period, others have demonstrated that loss of >5% of baseline body weight during radiation treatment may decrease the efficacy of treatment 27–29. Unfortunately, survival differences between both groups cannot be assessed here due to the relatively short follow-up time.…”

The value of the Prognostic Nutritional Index (PNI) in predicting outcomes and guiding the treatment strategy of nasopharyngeal carcinoma (NPC) patients receiving intensity-modulated radiotherapy (IMRT) with or without chemotherapy

“…According to the previous reports (Qiu et al 2011;Ravasco et al 2005;Capuano et al 2008;Shen et al 2013), malnutrition before and during treatment has been identified as a risk factor predicted worse outcome in head and neck cancer or NPC patients due to severity of acute toxicities, decreasing chemotherapy dose intensity, interruption of treatment, reducing the radiosensitivity and/ or chemosensitivity of tumour and compromised immunity. Although no delay or interruption of radiotherapy, or chemotherapy dose intensity reduction was observed in all patients in this study, we supposed that the nutritional status steadily deteriorated during CCRT in the patients with low PNI subgroup result in lower survival rates by reducing radiosensitivity and/or chemosensitivity, and compromised immunity.…”