Predictors of weight loss during radiotherapy in patients with stage I or II head and neck cancer

Abstract

BACKGROUND:The purpose of the study was to identify predictors of weight loss during radiotherapy (RT) in patients with stage I or II head and neck (HN) cancer. METHODS: This study was conducted as part of a phase 3 chemoprevention trial. A total of 540 patients were randomized. The patients were weighed before and after RT. Their baseline characteristics, including lifestyle habits, diet, and quality of life, were assessed as potential predictors. Predictors were identified using multiple linear regressions. The reliability of the model was assessed by bootstrap resampling. A receiver operating characteristics curve was generated to estimate the model's accuracy in predicting critical weight loss (!5%). RESULTS: The mean weight loss was 2.2 kg (standard deviation, 3.4). Five factors were associated with a greater weight loss: all HN cancer sites other than the glottic larynx (P<.001), higher pre-RT body weight (P<.001), stage II disease (P ¼ .002), dysphagia and/or odynophagia before RT (P ¼ .001), and a lower Karnofsky performance score (P ¼ .028). There was no association with pre-RT lifestyle habits, diet, or quality of life. The bootstrapping method confirmed the reliability of this predictive model. The area under the curve was 71.3% (95% confidence interval, 65.8-76.9), which represents an acceptable ability of the model to predict critical weight loss. CONCLUSIONS: These results could be useful to clinicians for screening patients with early stage HN cancer treated by RT who require special nutritional attention. Cancer 2010;116:2275-83.

A review of weight loss and sarcopenia in patients with head and neck cancer treated with chemoradiation

“…In part, this has been exacerbated by a change in resting energy expenditure, which furthers the loss of lean body mass seen during and immediately after treatment [11,15]. Predictors of excessive weight loss during treatment include higher weight at baseline, dysphagia at diagnosis, and higher stage tumors [16]. More specifically, a recent study from Denmark reported that patients with a body mass index (BMI) ≥ 25 are three times more likely to lose more than 5 % of baseline weight than patients with BMI < 25 (p < 0.0001) [12].…”

Influence of Chinese Medicine on Weight Loss and Quality of Life During Radiotherapy in Head and Neck Cancer

“…According to previous reports, numerous quality-of-life dimensions significantly correspond to body weight loss, 22 and scores of global quality of life are lower in patients with more than 10% weight loss. 23 In addition, there is deterioration of physical function and role function 3 months after surgery for oral cancers, which correlates with reduced body image because of a significant decrease in oral function.…”

Direct Puncture Endoscopic Assisted Gastrostomy: An Alternative Technique, Case Report

“…Approximately 60% of patient's present weight loss and chronic malnutrition affects approximately 20-57% of patients with head and neck neoplasia, reason why and early enteral feeding must be started to avoid or at least reduce complications and comorbidities [1,11,12,18,19,[26][27][28][29]. Nutritional assessment and intervention should be an integral part of treatment since this complication can lead to compromised treatment efficacy.…”

“…This group disserves particular attention since tumoral seeding in gastrostomy stomas have been reported [13][14][15][16][17], primary from the oropharynx, hypopharynx, oral cavity and larynx. Being the pull technique the most associated with metastases reports, reason why new methods for gastrostomy placement have been studied, especially for the ones that require pre-surgical feeding or for nutritional feeding after mayor head and neck surgical intervention [12,18,19]. With this purpose, general surgery and gastroenterology departments of the Fundación Santa Fé University Hospital of Bogotá Colombia presents an alternative technique: Direct puncture endoscopic assisted Gastrostomy reducing the risk of tumoral cell implant at the path and stoma.…”