Weight and body mass index in relation to irradiated volume and to overall survival in patients with oropharyngeal cancer: a retrospective cohort study

Abstract

BackgroundWeight loss is a common problem in patients with Squamous Cell Carcinoma of the Head and Neck (SCCHN) treated with radiotherapy (RT). The aims of the present study were to determine if treated volume (TV), as a measure of the radiation dose burden, can predict weight loss in patients with oropharyngeal cancer and to analyze weight loss and body mass index (BMI) in the same patient group in relation to 5-year overall survival.MethodsThe ARTSCAN trial is a prospective, randomized, multicenter trial in patients with SCCHN. Nutritional data from the ARTSCAN trial were analyzed retrospectively using univariate and multivariate statistical methods based on information on percentage weight loss from the start of RT up to five months after the termination of RT (study cohort 1, n = 232) and information on patients’ BMI at the start of RT (study cohort 2, n = 203). TV was defined as the volume of the patient receiving at least 95% of the prescribed dose. TV64.6 Gy encompasses macroscopic tumor and TV43.7 Gy elective lymph nodes of the neck.ResultsTV64.6 Gy and TV43.7 Gy were both significantly correlated with higher weight loss up to five months after the termination of RT in study cohort 1 (p < 0.001 for both). BMI at the start of RT was shown to be a prognostic factor for 5-year overall survival in study cohort 2 but weight loss was not. The hazard ratios and 95% confidence intervals were 3.78 (1.46–9.75) and 2.57 (1.43–4.62) in patients with underweight and normal weight, respectively.ConclusionsTV can predict weight loss during RT in patients with oropharyngeal cancer regardless of clinical stage. A high BMI (>25 kg/m2) at the start of RT is positively associated with survival in patients with oropharyngeal cancer.

Evaluation of long term (10-years+) dysphagia and trismus in patients treated with concurrent chemo-radiotherapy for advanced head and neck cancer

“…As supported by several studies [28,35,38,39], it seems reasonable to assume that prophylactic gastric tube placement leads to worse post-treatment swallowing and diet outcomes, since the swallowing muscles are no longer actively used and may atrophy (the ''use it or loose it'' principle) [39]. Weight loss during treatment is associated with worse oncological outcome [37], but it is not clear what loss is acceptable. However, initial body mass index (BMI) may play a role in that, since oropharyngeal cancer patients with a BMI > 25 at the start of treatment may have a better overall survival [37].…”

“…Weight loss during treatment is associated with worse oncological outcome [37], but it is not clear what loss is acceptable. However, initial body mass index (BMI) may play a role in that, since oropharyngeal cancer patients with a BMI > 25 at the start of treatment may have a better overall survival [37].…”

“…Regarding oral intake during treatment, the usefulness of prophylactic gastric tube placement to maintain weight and nutrition during treatment is currently under debate [36]. The controversy is mainly about maintaining weight during treatment versus maintaining swallowing function by training oral intake [37]. As supported by several studies [28,35,38,39], it seems reasonable to assume that prophylactic gastric tube placement leads to worse post-treatment swallowing and diet outcomes, since the swallowing muscles are no longer actively used and may atrophy (the ''use it or loose it'' principle) [39].…”

Quelle prise en charge nutritionnelle des patients atteints du cancer de la sphère oto-rhino-laryngée traités par la radiothérapie ? Une mise au point

“…Les facteurs prédictifs de la perte de poids durant la radiothérapie Vu le risque élevé de malnutrition, la recherche des facteurs prédictifs de la perte de poids au cours de la radiothérapie chez les patients atteints du cancer de la sphère ORL était le sujet de plusieurs études prospectives et rétrospectives [20][21][22][23][24]. Une étude prospective était menée par Mallick et al en 2013 [22] chez 103 patients irradiés pour cancer de la sphère ORL et chez qui le poids a été mesuré au début et à la fin du traitement.…”

“…L'âge, le sexe, le stade tumoral et la modalité de la radiothérapie (une radiothérapie conformationelle 3D ou une radiothérapie par modulation d'intensité) n'avaient pas dans cette étude un effet significatif sur la perte du poids. Une analyse rétrospective de l'essai randomisé multicentrique ARTSCAN publiée au Radiation Oncology Journal en 2014 [23] a évalué le poids des patients irradiés pour des carcinomes épi-dermoïdes de la sphère ORL depuis le début jusqu'à 5 mois de la fin de la radiothérapie. La perte de poids était significativement corrélée avec le PTV 64,6 Gy et le PTV 43,7 Gy jusqu'à 5 mois de la fin du traitement (p < 0,001).…”