Malnutrition and cachexia in patients with head and neck cancer treated with (chemo)radiotherapy

Gorenc, Mojca; Kozjek, Nada Rotovnik; Strojan, Primož

doi:10.1016/j.rpor.2015.03.001

Cited by 140 publications

(147 citation statements)

References 80 publications

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“…Unfortunately, nutritional deficits related to changes in body composition negatively affect the patients' survival, therapy outcomes, and quality of life. Therefore, based on the above‐mentioned unfavorable circumstances, the prediction of body composition changes during the course of RTH is desirable for selection of patients susceptible to malnutrition …”

Section: Discussionmentioning

confidence: 99%

Combined analysis of miRNA‐181a with phase angle derived from bioelectrical impedance predicts radiotherapy‐induced changes in body composition and survival of male patients with head and neck cancer

et al. 2019

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Background Nutritional deficits developing as an effect of applied radiotherapy (RTH) negatively affect patients' quality of life, survival, and therapy outcomes. We demonstrated novel approach to prediction of RTH‐induced changes in body composition of patients with head and neck cancer using phase angle (PA) derived from bioelectrical impedance in combination with miRNA‐181a expression. Results Patients with simultaneous presence of low PA and high miRNA expression were at a significantly higher risk of decreasing the fat‐free mass index (FFMI) <14.9 kg/m2 (odds ratio [OR] = 5.14; P = .02), FFM < 44.7 kg (OR = 6.20; P = .04), and lean mass (OR = 10.0; P = .04) during the therapy period. Receiver operating curve analysis allowed to predict changes in FFMI, lean mass, and FFM with area under the curve calculation over 0.700. The simultaneous presence of high miRNA and low PA negatively affected patients' survival (OR = 5.12; P = .02). Conclusion Evaluation of PA in combination with miRNA demonstrates higher diagnostic accuracy and predictive value for detecting RTH‐induced changes in body composition of patients with cancer.

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Section: Discussionmentioning

confidence: 99%

Combined analysis of miRNA‐181a with phase angle derived from bioelectrical impedance predicts radiotherapy‐induced changes in body composition and survival of male patients with head and neck cancer

et al. 2019

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“…Patients suffering from advanced cancer often develop cachexia, a multifactorial syndrome with unintended loss of skeletal muscle mass, caused by a variable combination of reduced food intake and changes in metabolic processes . In head and neck cancer (HNC) patients, the prevalence of cachexia is 3–52% at diagnosis, depending on tumour location and stage . Resection of tumours in the head and neck region can be truly mutilating, preventing sufficient oral intake, which can lead to increased weight loss.…”

Section: Introductionmentioning

confidence: 99%

Disease‐induced and treatment‐induced alterations in body composition in locally advanced head and neck squamous cell carcinoma

Willemsen

Hoeben

Lalisang

et al. 2019

J cachexia sarcopenia muscle

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Background Chemoradiation or bioradiation treatment (CRT/BRT) of locally advanced head and neck squamous cell carcinoma (LAHNSCC) comes with high toxicity rates, often leading to temporary tube feeding (TF) dependency. Cachexia is a common problem in LAHNSCC. Yet changes in body composition and muscle weakness during CRT/BRT are underexplored. Strong evidence on the effect of TF on body composition during treatment is lacking. The aim of this cohort study was to assess (i) the relationship of fat‐free mass index (FFMI) and handgrip strength (HGS) with CRT/BRT toxicity and outcome, (ii) body composition in patients treated with chemoradiation (cisplatin) vs. bioradiation (cetuximab), and (iii) the effect of the current TF regime on body composition and muscle strength. Methods Locally advanced head and neck squamous cell carcinoma patients treated with CRT/BRT between January 2013 and December 2016 were included (n = 137). Baseline measurements of body composition (bioelectrical impedance analysis) and HGS were performed. Toxicity grades (Common Terminology Criteria for Adverse Events) were scored. In a subset of 69 patients, weight loss, body composition, and HGS were additionally assessed during and after CRT/BRT. TF was initiated according to the Dutch guidelines for malnutrition. Results In this cohort (68% male, mean age 59 ± 8 years), the incidence of baseline muscle wasting, defined as FFMI < P10, was 29%. Muscle wasting was present in 23 of 100 (23%) chemoradiation patients and 17 of 37 (46%) bioradiation patients (P = 0.009). Muscle‐wasted patients required more unplanned hospitalizations during CRT (P = 0.035). In the chemoradiation subset, dose‐limiting toxicity was significantly higher in wasted vs. non‐wasted patients (57% vs. 25%, P = 0.004). Median follow‐up was 32 months. Multivariate Cox regression analysis identified muscle wasting as independent unfavourable prognostic factor for overall survival [hazard ratio 2.1 (95% CI 1.1–4.1), P = 0.022] and cisplatin as favourable prognostic factor [hazard ratio 0.3 (95% CI 0.2–0.6), P = 0.001]. Weight and HGS significantly decreased during CRT/BRT, −3.7 ± 3.5 kg (P < 0.001) and −3.1 ± 6.0 kg (P < 0.001), respectively. Sixty‐four per cent of the patients required TF 21 days (range 0–59) after CRT/BRT initiation. Total weight loss during CRT/BRT was significantly (P = 0.007) higher in the total oral diet group (5.5 ± 3.7 kg) compared with the TF group (3.0 ± 3.2 kg). Loss of FFM and HGS was similar in both groups. Conclusions In LAHNSCC patients undergoing CRT/BRT, FFMI < P10 is an unfavourable prognostic factor for overall survival, treatment toxicity, and tolerance. Patients experience significant weight and FFM loss during treatment. Current TF regime attenuates weight loss but does not overcome loss of muscle mass and function during therapy. Future interventions should consider nutritional intake and additional strategies specifically targeting metabolism, loss of muscle mass, and function.

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“…Cachexia is usually accompanied by anorexia and related to overproduction of pro-inflammatory cytokines, such as interleukins and tumor necrosis factor (TNF). The above-mentioned fact emphasizes crucial role of the inflammatory response in the pathogenesis of cachexia (Alshadwi et al 2013; Gorenc et al 2015; Ravasco et al 2003; Tisdale 2009). Currently, the molecular background of cachexia is still unknown, and therefore, it is difficult to identify patients who are likely to be cachectic.…”

Section: Introductionmentioning

confidence: 99%

“…Multiple biological activities of TNF-α were found in numerous physiological states, including the regulation of cell differentiation, proliferation, apoptosis and metabolism (Locksley et al 2001; Bazzoni and Beutler 1996). On the other hand, TNF-α was also recognized as a significant regulator of both inflammatory and autoimmune diseases and, moreover, it was implicated in inflammatory-associated tumors and the development of cachexia (Gorenc et al 2015; Beutler 1999). Up until now, several functional single-nucleotide polymorphisms (SNPs) within TNF-α gene have been identified and described as cancer related genetic alterations.…”

Section: Introductionmentioning

confidence: 99%

Relationship between TNF-α −1031T/C gene polymorphism, plasma level of TNF-α, and risk of cachexia in head and neck cancer patients

Powrózek

Mlak

Brzozowska

et al. 2018

J Cancer Res Clin Oncol

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BackgroundMalnutrition and cachexia are frequent among head and neck cancer (HNC) patients and these syndromes are associated with both poor quality of life and unfavorable disease prognosis. Unfortunately, there are still no established biomarkers that could predict the development of cachexia. Among potential molecular alterations related to cancer cachexia, there are single-nucleotide polymorphisms (SNPs) within genes encoding pro-inflammatory cytokines such as TNF-α.The aim of the studyTo investigate TNF-α −1031T/C SNP as a risk factor of cachexia in 62 HNC patients subjected to radiotherapy. DNA was isolated from whole blood samples and genotyping was conducted using real-time PCR method by means of TaqMan SNP Genotyping Assay. TNF-alpha Human ELISA Kit was used to determine TNF-α concentration in each extracted plasma sample. Moreover, the relationship between genotype variants of TNF-α and plasma level of TNF-α was examined. Detailed clinical–demographic and nutritional data were collected from each study participant.ResultsCC genotype carriers were at a significantly higher risk of being qualified as cachectic compared with other genotype carriers (p = 0.044; HR = 3.724). Subjects, who carried CC genotype had significantly lower body mass compared to patients with TT and CT genotype (p = 0.045). Moreover, CC individuals had the highest TNF-α plasma level (median 10.70 ± 0.72 pg/mL, p = 0.006) among the studied cases. We also noted, that CC genotype carriers had significantly higher risk of early death incidence compared to other genotype carriers [overall survival (OS): 28 vs 38 months (HR = 3.630, p = 0.013)].ConclusionDespite the differences between SGA and NRS scoring, the presence of CC genotype could be a useful objective marker allowing for the prediction of cachexia development in both parenterally nourished and non-parenterally nourished patients. Patients with CC genotype had also the highest risk of early death incidence; therefore, such individuals should be qualified for parenteral nutrition and supportive care at the time of diagnosis to improve further therapy outcomes. Moreover, this is the first study demonstrating the relationship between TNF-α −1031T/C polymorphism and plasma level of TNF-α. This is also the first paper investigating the role of TNF-α −1031T/C in cancer cachexia.

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Malnutrition and cachexia in patients with head and neck cancer treated with (chemo)radiotherapy

Abstract: Nutritional management is an essential part of care of these patients, including early screening, assessment of nutritional status and appropriate intervention.

Cited by 140 publications

References 80 publications

Combined analysis of miRNA‐181a with phase angle derived from bioelectrical impedance predicts radiotherapy‐induced changes in body composition and survival of male patients with head and neck cancer

Combined analysis of miRNA‐181a with phase angle derived from bioelectrical impedance predicts radiotherapy‐induced changes in body composition and survival of male patients with head and neck cancer

Disease‐induced and treatment‐induced alterations in body composition in locally advanced head and neck squamous cell carcinoma

Relationship between TNF-α −1031T/C gene polymorphism, plasma level of TNF-α, and risk of cachexia in head and neck cancer patients

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