Nutritional Support in Head and Neck Radiotherapy Patients Considering HPV Status

Abstract

Malnutrition is a common problem in patients with head and neck cancer (HNC), including oropharyngeal cancer (OPC). It is caused by insufficient food intake due to dysphagia, odynophagia, and a lack of appetite caused by the tumor. It is also secondary to the oncological treatment of the basic disease, such as radiotherapy (RT) and chemoradiotherapy (CRT), as a consequence of mucositis with the dry mouth, loss of taste, and dysphagia. The severe dysphagia leads to a definitive total impossibility of eating through the mouth in 20–30% of patients. These patients usually require enteral nutritional support. Feeding tubes are a commonly used nutritional intervention during radiotherapy, most frequently percutaneous gastrostomy tube. Recently, a novel HPV-related type of OPC has been described. Patients with HPV-associated OPC are different from the HPV− ones. Typical HPV− OPC is associated with smoking and alcohol abuse. Patients with HPV+ OPC are younger and healthy (without comorbidities) at diagnosis compared to HPV− ones. Patients with OPC are at high nutritional risk, and therefore, they require nutritional support in order to improve the treatment results and quality of life. Some authors noted the high incidence of critical weight loss (CWL) in patients with HPV-related OPC. Other authors have observed the increased acute toxicities during oncological treatment in HPV+ OPC patients compared to HPV− ones. The aim of this paper is to review and discuss the indications for nutritional support and the kinds of nutrition, including immunonutrition (IN), in HNC, particularly OPC patients, undergoing RT/CRT, considering HPV status.

Effects of Immunonutrition in Head and Neck Cancer Patients Undergoing Cancer Treatment – A Systematic Review

“…It is also the precursor for amino acids, proteins, nucleotides synthesis, and ammoniagenesis in the kidneys ( 45 ). Hence, glutamine may be beneficial in reducing mucosal damage during cancer treatment, including mucositis, stomatitis, pharyngitis, esophagitis and enteritis; and promote mucosal healing during and post-cancer treatment ( 46 , 47 ). Arginine is involved in nucleotides, polyamines, nitric oxide, ornithine, citrulline and proline synthesis.…”

“…Arginine is involved in nucleotides, polyamines, nitric oxide, ornithine, citrulline and proline synthesis. Therefore, arginine has an essential role in the modulation of immune function, regulation of blood flow, angiogenesis and wound healing ( 46 , 48 ). Omega-3 fatty acids, namely eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), modulates the immune system by reducing the production of pro-inflammatory arachidonic acid (AA) and competes with AA for cyclooxygenase and lipoxygenase enzymes ( 49 ).…”

12th “Jesús Culebras” Lesson. Feeding and nutrition in patients with head and neck cancer — a permanent challenge

“…En los últimos años se hace especial mención a los enfermos con cáncer de orofaringe por el virus del papiloma humano (HPV) (2). En un principio su pronóstico, desde el punto de vista oncológico, es mejor que el de los enfermos con cáncer de orofaringe no asociado al HPV y, en el momento del diagnóstico, su estado nutricional es mejor.…”

“…La prevalencia de la disfagia en los enfermos de cáncer de cabeza y cuello se sitúa entre el 50 y el 80 %. Hay que destacar que está presente al diagnóstico en el 30-50 % de los pacientes y que tiene graves efectos secundarios a corto, medio y largo plazo (2). En el 20-30 % de los enfermos la disfagia es permanente.…”

“…El riesgo nutricional y/o la desnutrición existen en los enfermos con cáncer de cabeza y cuello desde antes del diagnóstico y a corto, medio y largo plazo después, aunque el tratamiento oncológico instaurado (cirugía, radioterapia, quimioterapia) haya sido eficaz y el enfermo esté en remisión completa. De hecho, el 72 % de estos pacientes desarrollan algún grado de desnutrición en el transcurso de la enfermedad (1,2).…”