Impact of nutrition support on treatment outcome in patients with locally advanced head and neck squamous cell cancer treated with definitive radiotherapy: A secondary analysis of RTOG trial 90-03

Rabinovitch, Rachel; Grant, Barbara L.; Berkey, Brian; Raben, David; Ang, K. Kian; Fu, Karen K.; Cooper, Jay S.

doi:10.1002/hed.20335

Cited by 100 publications

(60 citation statements)

References 39 publications

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“…For example, in a prospective study of patients with HNSCC undergoing RT, Ravasco and colleagues found that nutritional counseling with regular foods was superior to only adding nutritional supplements in maintaining quality of life during and at 3 months post-RT, but the impact of these interventions on weight was not reported [44]. In a large retrospective review of patients on RTOG 90-03, investigators performed a secondary analysis of patients with HNSCC treated with four different radiation strategies, Rabinovitch and colleagues found that beginning nutritional supplementation before starting RT was a negative prognostic indicator for locoregional failure and death, HR 1.47, 95 % CI 1.21-1.79, p < .0001 and HR 1.41, 95 % CI 1.19-1.67, p < .0001, respectively [45]. Given the retrospective nature of this analysis, nutritional supplement was likely initiated pre-RT in patients who presented with weight loss at diagnosis.…”

Section: Main Textmentioning

confidence: 99%

A review of weight loss and sarcopenia in patients with head and neck cancer treated with chemoradiation

2016

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Background: Concurrent chemotherapy and radiation (CTRT) improves disease-free survival in locally advanced head and neck cancer but is associated with numerous acute and chronic toxicities resulting in substantial alterations in body mass and composition. We aim to summarize the current evidence on body composition changes experienced by patients undergoing CTRT, examine the impact of these changes on clinical outcomes and address potential interventions aimed at mitigating the loss. Main Body: Loss of 20 % of pre-CTRT weight predicts poorer treatment tolerance and 30-day mortality. While clinical practice focuses on body weight, emerging data indicates that CTRT causes profound adverse changes in lean body mass (sarcopenia). Higher prevalence of sarcopenia predicts poorer disease-free survival as well as overall survival, lower quality of life and functional performance. The magnitude of CTRT-induced sarcopenia is the equivalent to that observed in a decade of aging in a healthy adult. Alterations in body composition are only explained, in part, by decreased caloric intake; other significant predictors include body mass index, stage, and dysphagia. Lifestyle interventions aimed at preventing loss of whole-body and especially lean mass include nutritional counseling, nutritional supplements, dietary supplements and exercise training. Personalized nutritional counseling has been associated with improvement in quality of life, while the benefits of feeding tube placement are inconsistent. There are inconsistently reported benefits of resistance training in this population. Conclusion: Patients with head and neck cancer undergoing CTRT therapy experience dramatic shifts in body composition, including sarcopenia, which can negatively impact clinical outcomes. Efforts to understand the magnitude, clinical importance and mechanisms of sarcopenia are needed to inform a more personalized approach to mitigating the body composition changes associated with CTRT.

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Section: Main Textmentioning

confidence: 99%

A review of weight loss and sarcopenia in patients with head and neck cancer treated with chemoradiation

2016

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“…[83][84][85][86] One study of upper GI cancer patients indicated less weight loss and fewer treatment interruptions in patients who received EN prior to radiation therapy (XRT). 83 Two studies in head and neck cancer patients failed to demonstrate reduced weight loss 84 ; furthermore, worse survival 85 Rationale: NST is appropriate in patients receiving active anticancer treatment who are malnourished and who will be unable to absorb adequate nutrients for a prolonged period of time to minimize risk of poor outcomes associated with malnutrition. Seven to fourteen days seems an appropriate definition of "prolonged period of time"; this time period is referred to in many studies, although there are no well designed studies that specifically address this issue.…”

Section: Practice Guidelines and Rationalesmentioning

confidence: 99%

“…81,82 The strength of this guideline is tempered by the fact that the best and largest RCT is limited to a head and neck population receiving radiation. 85 See Table A6. 7. The palliative use of nutrition support therapy in terminally ill cancer patients is rarely indicated.…”

Section: Practice Guidelines and Rationalesmentioning

confidence: 99%

A.S.P.E.N. Clinical Guidelines: Nutrition Support Therapy During Adult Anticancer Treatment and in Hematopoietic Cell Transplantation

August

Huhmann

2009

J Parenter Enteral Nutr

441

279

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“…7,[12][13][14] Several studies have shown nutritional interventions in HN cancer patients to have a positive impact on their nutritional status, quality of life, and treatment compliance. [15][16][17] In HN cancer patients, several factors contribute to weight loss before, during, and after treatment. Weight loss is usually attributed to the physiological abnormalities associated with the tumor (because of obstruction and interference with swallowing), the tumor host response (such as chronic inflammation and cytokine production), and the adverse effects of cancer treatments.…”

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confidence: 99%

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

Nourissat

Bairati

Samson

et al. 2010

Cancer

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BACKGROUND:The purpose of the study was to identify predictors of weight loss during radiotherapy (RT) in patients with stage I or II head and neck (HN) cancer. METHODS: This study was conducted as part of a phase 3 chemoprevention trial. A total of 540 patients were randomized. The patients were weighed before and after RT. Their baseline characteristics, including lifestyle habits, diet, and quality of life, were assessed as potential predictors. Predictors were identified using multiple linear regressions. The reliability of the model was assessed by bootstrap resampling. A receiver operating characteristics curve was generated to estimate the model's accuracy in predicting critical weight loss (!5%). RESULTS: The mean weight loss was 2.2 kg (standard deviation, 3.4). Five factors were associated with a greater weight loss: all HN cancer sites other than the glottic larynx (P<.001), higher pre-RT body weight (P<.001), stage II disease (P ¼ .002), dysphagia and/or odynophagia before RT (P ¼ .001), and a lower Karnofsky performance score (P ¼ .028). There was no association with pre-RT lifestyle habits, diet, or quality of life. The bootstrapping method confirmed the reliability of this predictive model. The area under the curve was 71.3% (95% confidence interval, 65.8-76.9), which represents an acceptable ability of the model to predict critical weight loss. CONCLUSIONS: These results could be useful to clinicians for screening patients with early stage HN cancer treated by RT who require special nutritional attention. Cancer 2010;116:2275-83.

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Impact of nutrition support on treatment outcome in patients with locally advanced head and neck squamous cell cancer treated with definitive radiotherapy: A secondary analysis of RTOG trial 90-03

Cited by 100 publications

References 39 publications

A review of weight loss and sarcopenia in patients with head and neck cancer treated with chemoradiation

A review of weight loss and sarcopenia in patients with head and neck cancer treated with chemoradiation

A.S.P.E.N. Clinical Guidelines: Nutrition Support Therapy During Adult Anticancer Treatment and in Hematopoietic Cell Transplantation

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

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