<p>Competing Morbidities In Advanced Head And Neck Squamous Cell Carcinoma Concurrent Chemoradiotherapy: A Strong Implication Of A Multidisciplinary Team Approach</p>

Abstract

Concurrent chemoradiotherapy (CCRT) is the standard approach for the treatment of locally advanced head and neck squamous cell carcinoma. Despite its undisputed advantages, CCRT is associated with acute and late toxicities, leading to unfavorable implications (eg, unplanned interruptions and noncancer-related mortality). The former prolongs the overall treatment time leading to a detrimental effect on tumor control. The latter consists of several noncancer morbidities arising from treatment-related toxicities, identifying a new pathway in cancer fate. This pathway has been termed noncancer mortality or competing mortality and consists of a series of treatment-competing morbidities, which nullify all therapeutic efforts aimed at curing these patients. The management of patients with head and neck squamous cell carcinoma who experience treatment-related toxicities is complex and requires expertise in oncological treatment as well as supportive care. The optimal management of these patients should start with knowledge regarding the most important competing morbidities developing during all phases of the disease (ie, from diagnosis to follow-up) to minimize treatment interruptions, ensure appropriate psychological support, and achieve the best oncological result. The purpose of the present review is to analyze the most important competing morbidities due to patient’s condition at baseline and CCRT, which could result in noncancer mortality. A multidisciplinary team approach is strongly required in the management of this disease.

Nutritional Care in Patients with Head and Neck Cancer during Chemoradiotherapy (CRT) and Bioradiotherapy (BRT) Provides Better Compliance with the Treatment Plan

“…A decrease in treatment intensity worsens the objective response rate and long-term survival and is observed after both RTH and chemotherapy de-escalation [ 12 ]. Receiving no less than 50 Gy of cumulative RTH dose confers a therapeutic benefit [ 13 , 14 ]. Higher cumulative doses of weekly cisplatin regimens have superior efficacy in progression-free survival and overall survival compared to regimens with lower weekly doses [ 15 ].…”

“…Higher cumulative doses of weekly cisplatin regimens have superior efficacy in progression-free survival and overall survival compared to regimens with lower weekly doses [ 15 ]. The recommended cumulative dose of concomitant cisplatin used along with RTH is over 200 mg/m 2 [ 14 , 15 ]. A decrease in the cytostatic dose even by 20% worsens therapeutical outcomes by approximately 50% [ 16 ].…”

“…A decrease in the cytostatic dose even by 20% worsens therapeutical outcomes by approximately 50% [ 16 ]. Therefore, the dose reductions in patients with HNC that occur even in 41–61% are highly disadvantageous [ 14 , 17 ].…”

A Predictive Model for Reactive Tube Feeding in Head and Neck Cancer Patients Undergoing Definitive (Chemo) Radiotherapy

“…The careful management of a patient's nutritional status during and after treatment for head and neck squamous cell cancers (HNSCC) is crucial for optimal outcomes [1,2]. Malnutrition can be mitigated through patient education, careful monitoring and targeted interventions [3,4].…”

Comorbidity, Radiation Duration, and Pretreatment Body Muscle Mass Predict Early Treatment Failure in Taiwanese Patients with Locally Advanced Oral Cavity Squamous Cell Carcinoma after Completion of Adjuvant Concurrent Chemoradiotherapy

“…Lastly, blood NIMs are interrelated and their influences are usually confounded by comorbidities or treatment-related toxicity rather than malnutrition alone [ 6 ]. Treatment-related toxicity exerts a detrimental effect on disease control and remains one of the major causes of unplanned schedule interruption, prolonging the overall treatment duration [ 18 ]. To identify the potential risk factors of early treatment failure, a prospective study recruiting LAHNC patients with homogeneous tumor location, stage, histology and treatment modality, and simultaneously analyzing the interplay effects between clinicopathological characteristics, treatment-related variables (dose and toxicity), and nutritional profile should be conducted.…”