Weight Loss During Radiotherapy for Head and Neck Malignancies: What Factors Impact It?

Abstract

Radiotherapy (RT) is an important treatment modality in head and neck cancers. Loss of weight during RT due to various factors is a matter of concern. This study was conducted to see the pattern of weight loss and the causative factors involved. One hundred forty patients with head and neck cancer treated with radical RT, concurrent chemoradiation, or postoperative RT were retrospectively studied. A dose of 70 Gy was given in the radical and in the chemoradiation schedule. In postoperative RT, a dose of 60-64 Gy was delivered. During the weekly review of the patients, serial recording of their weight was done along with measurement of other parameters. Analysis was done to see which factors were causative in patients having a weight loss of >5 kg and of >10%. Three variables were found to be significant for the >5-kg weight loss. These were a low initial Karnofsky performance score (KPS; P < 0.001), use of chemoradiation (P < 0.001), and a total dose of >60 Gy (P = 0.04). For the >10% weight loss, the significant factors were low initial KPS (P < 0.001) and use of chemoradiation (P < 0.001). Therefore, it is important to take care of the nutrition of those patients who have a low KPS, are on chemoradiation, or will be delivered a dose of >60 Gy. The role of prophylactic Ryle's tube placement or agents such as megestrol acetate in such patients should be further investigated.

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

“…In a retrospective study involving 140 HN cancer patients, Munshi et al found that a pretreatment KPS >80 was associated with lower weight loss during RT. 21 Only the pretreatment weight was positively and linearly associated with weight loss in our study. When body mass index (weight/height 2 ) was considered in the final model instead of baseline body weight, similar results were observed (data not shown).…”

“…Literature data suggest that this percentage is probably underestimated, because weight loss is already observed before diagnosis and can continue after treatment. 5,6,8,14,21,43 Jager-Wittenaar et al report that 19% of the HN cancer patients, all stages combined, had experienced critical weight loss before treatment. 6 In a study of 249 all-stage HN cancer patients, Beaver et al found those who had lost >7% of their body mass index before their cancer treatment had a significantly higher incidence of severe weight loss during RT.…”

“…Lastly, multivariate analyses are not always performed. 8,21,23 To our knowledge, our study is 1 of the largest cohort studies conducted among early stage HN cancer patients. The characteristics of the patients and of their disease were systematically and prospectively collected using validated, structured questionnaires.…”

“…6,8,19 Several studies suggest that global health status, diet, and quality of life can influence the ability of cancer patients to maintain adequate nutritional intake during their cancer treatments. 14,[20][21][22][23] To prevent therapy-associated weight loss and interruptions of RT, clinical guidelines recommend the use of intensive dietary counseling and oral nutritional supplements. 24 The modalities of nutritional support in HN cancer patients are still debated with regard to both the enteral feeding methods and what the supplemental formula should contain.…”

Exploration of risk factors for weight loss in head and neck cancer patients

“…Further study in this area is required to understand causal relationships and potential corrective interventions, whether they be nutritional, or psychological. Munshi et al 26 Poor performance status, chemoradiotherapy and doses >60…”