Critical weight loss is a major prognostic indicator for disease-specific survival in patients with head and neck cancer receiving radiotherapy

Abstract

Background:Pre-treatment weight loss (WL) is a prognostic indicator for overall survival (OS) in head and neck cancer (HNC) patients. This study investigates the association between WL before or during radiotherapy and disease-specific survival (DSS) in HNC patients.Methods:In 1340 newly diagnosed HNC patients, weight change was collected before and during (adjuvant) radiotherapy with curative intent. Critical WL during radiotherapy was defined as >5% WL during radiotherapy or >7.5% WL until week 12. Differences in 5-year OS and DSS between WL groups were analysed by Cox's regression with adjustments for important socio-demographic and tumour-related confounders.Results:Before radiotherapy, 70% of patients had no WL, 16% had ⩽5% WL, 9% had >5–10% WL, and 5% had >10% WL. Five-year OS and DSS rates for these groups were 71%, 59%, 47%, and 42% (P<0.001), and 86%, 86%, 81%, and 71%, respectively (P<0.001). After adjustment for potential confounders, >10% WL before radiotherapy remained significantly associated with a worse OS (HR 1.7; 95% CI 1.2–2.5; P=0.002) and DSS (HR 2.1; 95% CI 1.2–3.5; P=0.007).The 5-year OS and DSS rates for patients with critical WL during radiotherapy were 62% and 82%, compared with 70% and 89% for patients without critical WL (P=0.01; P=0.001). After adjustment, critical WL during radiotherapy remained significantly associated with a worse DSS (HR 1.7; 95% CI 1.2–2.4; P=0.004).Conclusion:Weight loss both before and during radiotherapy are important prognostic indicators for 5-year DSS in HNC patients. Randomised studies into the prognostic effect of nutritional intervention are needed.

Nutritional support in patients with squamous cell carcinoma of the oropharyngeal area

“…По их данным, общая 5-летняя выживаемость в группе больных без нутритивной не-достаточности до и во время лечения равнялась 71 %; в тех случаях, когда потеря массы тела составляла от 5 до 10 %, общая 5-летняя выживаемость снижалась до 59 %, а при значительной потере (более 10 %) массы тела -не превышала 42 % (рис. 3) [13].…”

“…Так, в группе больных с умеренной потерей массы тела 5-летняя безрецидивная выживаемость составила 89 % против 82 % у пациентов с выраженным дефицитом массы тела (рис. 4) [13]. При оценке влияния нутритивной поддержки на результаты хирургического лечения отмечается сходная тенденция.…”

Optimising nutrition support in patients with head and neck cancer

“…It has been associated with moderate-severe malnutrition and therefore is considered a simple valuable measure to use for this purpose (Attar et al, 2012). Significant weight loss has also been shown to negatively impact on patient and clinical outcomes, such as quality of life (Langius et al, 2013a) and survival (Langius et al, 2013b;Martin et al, 2015), and thus is a clinically significant measure readily available from retrospective data collection.…”

“…In a long-term follow-up study of their colorectal cohort -the patients with dietary counselling had better QOL and survival; with depleted nutritional intake/status predictive of shorter survival and late toxicity (Ravasco, Monteiro-Grillo, & Camilo, 2012). Meanwhile a study of HNC patients (n=1340), found weight loss was also a major prognostic indicator for survival (Langius et al, 2013b). The study reported >10% weight loss pre-treatment was associated with worse overall survival and disease-specific survival.…”

“…Patients should be screened for malnutrition risk at diagnosis (Isenring et al, 2013;Watterson et al, 2009), as pre-treatment weight loss and malnutrition have been associated with reduced survival outcomes (Kubrak et al, 2010;Platek et al, 2010). Many studies frequently classify severity of weight loss outcomes using the accepted definition of clinically significant weight loss >10% (National Centre for Classification in Health, 2010), however poorer survival outcomes have been shown with weight loss <10% (Langius et al, 2013b;Martin et al, 2015). Therefore it is also important to recognise patients who may be well-nourished at diagnosis but are at future risk of nutritional deterioration, and provide appropriate timely intervention and education (Talwar, Donnelly, Skelly, & Donaldson, 2016).…”