Survival is Increased in Patients Developing Severe Weight Loss During Concommitant Chemotherapy and Radiation Therapy for Advanced Operable Stage III and IV Squamous Cell Carcinoma of the Head and Neck.
The nutritional support of SCCHN patients provides a challenge unique to this population, as weight loss is often multifactorial.1-3 Nausea, vomiting, and altered taste sense commonly preclude adequate nutritional intake in cancer patients.4 Cancer associated cachexia (CAC), a dysregulation of host inflammatory responses, leads to marked and rapid decrease in skeletal muscle and white adipose tissue mass.
With the approval of the Inspira Health Network’s Institutional Review Board (IRB), records of 49 patients with Stage III and IV, clinically operable SCCHN who underwent high-dose radiotherapy and concomitant chemotherapy (CTRT). One might have speculated that severe weight loss during CTRT would result in poor tumor response and increased recurrent disease; however, in this investigation SCWL patients did not fare worse than NSCWL, but had numerically superior CCR and HCR (75% vs. 25%), and recurrence (30% vs. 44%) rates. Those investigators also reported significantly decreased distant metastasis free survival with weight loss before treatment of >5-10% and >10% as well as a nonsignificant survival benefit in the weight loss during treatment groups of >5-10% and >10%.
Improved overall survival and DFS in clinically malnourished patients who lost a severe percentage of pre-treatment weight is a new contribution to the literature. Patients in the SCWL group not only had improved OS and DFS but also had no increased rates or severity of toxicity to treatment. The local/regional control and recurrence data in our study mirrors published data of improved control and decrease recurrence in patients losing significant amounts of weight during treatment, however both of us fell short of being statistically significant.
Otolaryngol Open J. 2017; SE(6): S17-S23. doi: 10.17140/OTLOJ-SE-6-103