Abstract
Background: The aim of present study was to assess the change in nutritional status of locally advanced head and neck carcinoma patients (LAHNC), who were treated by concomitant chemo-radiation, using Body Mass Index(BMI) and the nutritional status was correlated with local control of disease and the side effects of treatment.
Methods: The present study was conducted in 60 previously untreated, histopathologically proven locally advanced head and neck cancer patients who received conventional radical external beam radiation therapy (66Gy / 33 fractions over 6.3 weeks / 2 Gy per fraction) concomitant with Inj.Cisplatin 75mg/m2, 3 weekly. Nutritional status of patients was performed at time of presentation, at the end of treatment and three months after completion of treatment by using Body Mass Index (BMI).
Result: Thirty five percent patients were mild/moderate underweight and none were severely underweight (BMI 16) before starting treatment. At the end of treatment, 28.33%of patients were mild/moderate underweight (BMI 16.0-18.49) and 33.33% were severely underweight (BMI <16).Approximately forty one percent of patients were mild/moderate underweight and 21.67% of patients were severely underweight at third month of follow up. Grade 3 acute skin radiation reactions were seen in 38.10% mild/moderate underweight patients and 42.87% of obese patients(p value-0.001).Grade 3 acute mucosal radiation reactions were seen in 42.86% mild/moderate underweight patients and 57.14% of patients of obese patients. Complete response was seen in 85.71% mild/moderate underweight patients at end of treatment. No evidence of disease was seen in 80.96% mild/moderate underweight patients at third month of follow up.
Conclusion: The current study concludes that prevalence of underweight patients increases shortly after concomitant chemo-radiation in locally advanced head and neck cancer patients. Subsequently, prevalence of underweight patients substantially decreases during the first three months after treatment.
Keywords: Cancer, head and neck, concomitant chemo-radiation, body mass index, nutrition assessment.
References
- Alshadwi A, Nadershah M, Carlson ER, Young LS, Burke PA, Daley BJ. Nutritional considerations for head and neck cancer patients: a review of the literature. J Oral Maxillofac Surg. 2013;7:1853-60.
- Gorenc M, Kozjek NR, Strojan P. Malnutrition and cachexia in patients with head and neck cancer treated with (chemo) radiotherapy. Reports of Practical Oncology and Radiotherapy. 2015;20:249-58
- Jager-Wittenaar H, Dijkstra PU, Vissink A, Langendijk JA, van der Laan BF, Pruim J, et al. Changes in nutritional status and dietary intake duringand after head and neck cancer treatment. Head Neck. 2011 ;33:863-70.
- Prevost V, Joubert C, Heutte N, Babin E. Assessment of nutritional status and quality of life in patients treated for Head Neck cancer. Eur Ann Otorhinolaryngol HeadNeck Dis. 2014;131(2):113-20.
- Kumar, Nagi B. Assessment of Malnutrition and Nutritional Therapy Approaches in Cancer Patients. In: Nutritional assessment of cancer treatment effects. Berlin: Springer, 2012;7-41.
- Arribas L, Hurtós L, Milà R, Fort E, Peiró I. Predict factors associated with malnutrition from patient generated subjective global assessment (PG-SGA) inhead and neck cancer patients. Nutr Hosp. 2013;28(1):155-63.
- Singh N, Aggarwal AN, Gupta D, and Behera D. Prevalence of low body mass index among newly diagnosed lung cancer patients in North India and its association with smoking status. Thoracic Cancer.2011(2): 27–31.
- Chatterjee D, Roy S, Hazra A, Dasgupta P, Ganguly S, Das AK. Variation ofadverse drug reaction profile of platinum-based chemotherapy with body mass indexin patients with solid tumors: an observational study. Indian J Pharmacol. 2014;46:222-4.
- Meyer F, Fortin A, Wang CS, Liu G, Bairati I. Predictors of severe acute and late toxicities in patients with localized head-and-neck cancer treated with radiation therapy. Int J Radiat Oncol Biol Phys. 2012;82:1454-62.
- Jain AK, Salama JK, Stenson KM, Blair E, Cohen EE, Witt M, et al. Correlation of body massindex with toxicity and survival in locoregionally advanced head and neck cancer patients treated with induction chemotherapy and concurrent chemoradiotherapy. J Clin Oncol 2009;27.
- Egestad H, Nieder C. Differences in quality of life in obese and normal weight head and neck cancer patients undergoing radiation therapy. Support Care Cancer. 2015;23:1081-90.
- Huang PY, Wang CT, Cao KJ, Guo X, Guo L, Mo HY, et al. Pretreatment body mass index as an independent prognostic factor in patients with locoregionally advanced nasopharyngeal carcinoma treated with chemoradiotherapy: findings from a randomised trial. Eur J Cancer,2013;49:1923–31.
- Takenaka Y, Takemoto N, Nakahara S, Yamamoto Y, Yasui T, Hanamoto A, et al. (2015), Prognostic significance of body mass index before treatment for head and neck cancer. Head Neck, 37: 1518–1523
- Hu JY, Wei YI, Xia YF, Gao J, Liu ZG, Tao YL. Impact of pretreatmentbody mass index on prognosis of nasopharyngeal carcinoma. Chin JCancer 2009;28.
- Arthur AE, Peterson KE, Rozek LS, Taylor JMG, Light E, ChepehaDB, et al. UM head and neck SPORE program. Pretreatment dietarypatterns, weight status, and head and neck squamous cell carcinomaprognosis. Am J Clin Nutr 2013;97:360–8.
Corresponding Author
Ashutosh Kumar
Radiation oncologist, Civil Hospital, Yamunanagar, Haryana, India
DOI: https://dx.doi.org/10.18535/jmscr/v7i8.121
