The impact of nutritional counseling on thyroid disorders in head and neck cancer patients after (chemo)radiotherapy: results from a prospective interventional trial

Abstract

Objective To analyze the impact of nutritional counseling on the development of hypothyroidism after (chemo)radiotherapy in head and neck cancer patients to propose a new normal tissue complication probability (NTCP) model. Materials and methods At baseline, at the end of (chemo)radiotherapy, and during follow-up, thyroid-stimulating hormone (TSH) with free thyroxin (fT3 and fT4), nutritional status, and nutrient intake were prospectively analyzed in 46 out of 220 screened patients. Patients received (chemo)radiotherapy within an intervention (individual nutritional counseling every 2 weeks during therapy) and a control group (no nutritional counseling). Results Overall median follow-up was 16.5 [IQR: 12; 22] months. Fourteen patients (30.4%) presented with hypothyroidism after 13.5 [8.8; 17] months. During (chemo)radiotherapy, nutritional status worsened in the entire cohort: body mass index (p < 0.001) and fat-free mass index (p < 0.001) decreased, calorie deficit (p = 0.02) increased, and the baseline protein intake dropped (p = 0.028). The baseline selenium intake (p = 0.002) increased until the end of therapy. Application of the NTCP models by Rønjom, Cella, and Boomsma et al. resulted in good performance of all three models, with an AUC ranging from 0.76 to 0.78. Our newly developed NTCP model was based on baseline TSH and baseline ferritin. Model performance was good, receiving an AUC of 0.76 (95% CI: 0.61–0.87), with a sensitivity of 57.1% and specificity of 96.9% calculated for a Youden index of 0.73 (p = 0.004; area = 0.5). Conclusion Baseline TSH and ferritin act as independent predictors for radiotherapy-associated hypothyroidism. The exclusion of such laboratory chemistry parameters in future NTCP models may result in poor model performance.

Impact of a ketogenic diet intervention during radiotherapy on body composition: V. Final results of the KETOCOMP study for head and neck cancer patients

“…The impact of nutritional counselling alone on nutritional status of HNC patients during radiochemotherapy is hard to predict, as recent studies found either no [ 49 ] or a significant difference to the no-counselling group [ 50 ]. A better strategy appears to be nutritional counselling plus the delivery of calorie-dense, high-protein, and omega‑3 fatty acid-enriched supplements, which was shown to lead to significantly less BM loss than nutritional counselling alone [ 11 ].…”

Impact of dosimetric factors on long-term percutaneous enteral gastrostomy (PEG) tube dependence in head and neck cancer patients after (chemo)radiotherapy—results from a prospective randomized trial

“…Data on our therapy procedure have previously been published [ 7 – 9 ]. Briefly, patients were referred to our department for either definitive or adjuvant radiotherapy (IMRT with 1.7–2.0 Gy, 5 times/week, to cumulative doses ranging from 60–70.4 Gy [ 10 , 11 ]) alone or combined chemoradiotherapy with mainly cisplatin (100 mg/m 2 3‑weekly or 40 mg/m 2 weekly) or with 5‑fluorouracil (5-FU)/mitomycin C (MMC) (600 mg/m 2 on days 1–5 and 10 mg/m 2 on days 5 and 36, respectively).…”

Cost effectiveness and health-related quality of life of chemoradiotherapy versus radiation therapy alone in elderly head and neck cancer patients

“…Curative treatment of elderly HNC patients often requires multimodal approaches including surgery, radiotherapy (RT), or concomitant chemoradiation (CRT), but therapy is often complicated by reduced patient performance or comorbidities. Additionally, treatment-related toxicities commonly require intensified medical procedures and additional supportive care in elderly patients, resulting in substantial healthcare resource requirements and costs [3][4][5][6]. In this respect, it is important to compare increased treatment-related costs to benefits in treatment outcomes and patients' health-related quality of life (HRQoL) [7][8][9].…”