The impact of nutritional support in head and neck cancer patients treated with chemoradiation therapy

Abstract

Background: Head and neck cancer patients are frequently malnourished at the time of diagnosis and prior to the beginning of treatment. In addition, chemo-radiotherapy (CRT) causes or exacerbates symptoms, such as alteration or loss of taste, mucositis, xerostomia, fatigue, nausea and vomiting, with consequent worsening of malnutrition. Patients and methods: All patients undergoing CRT (60-70 Gy plus concomitant weekly cisplatin at 40 mg/sqm) for head and neck cancer (adjuvant or neoadjuvant setting) underwent to a nutritional evaluation before the beginning of the treatment, in order to pre-plan the best nutritional support for each of them. Results: 55 patients, mostly affected by oropharyngeal (47.3%), nasopharyngeal (18.2%) and oral (14.5%) cancer, have been evaluated. The cancer stage at time of CRT was: cII 3.6%, cIII 8%, cIVA 43.6%, cIVB 7.3%, pIII 1.8%, pIVA 11%. CRT program has been completed in all patients. 92.8% of them received artificial nutrition during the treatment: 41.8% parenteral nutrition (PN), 29.1% enteral nutrition through PEG (EN), 21.9% oral support (oral supplement containing eicosapentaenoic acid or/and progesterone derivates) only. The choice of artificial nutrition modality (EN vs. PN) was unrelated to disease stage (cIII 28.6% vs. 71.4%, cIVA 50% vs. 50%, cIVB 50% vs. 50%, pIVA 44.4% vs. 55.6% respectively). Effects on nutritional status were evaluated in terms of weight maintenance, body composition and biochemical modifications from baseline. EN seems to guarantee the best results for all variables: weight (-0.45 kg), albumin serum levels (+0.40ng/dl), prealbumin serum levels (+1.28mg/dl), transferrin serum levels (+19.00mg/dl), fat body mass (-1.08kgl), fat free body mass (+0.40kg), total body water (-0.52kg) median variations. Furthermore, a trend toward lower incidence of gr. 3-4 oral mucositis in the EN than in the PN subgroup (50% vs. 66.7% respectively) has been observed, as well as a trend for shorter duration of mucositis (14.68 +/- 19.14 days vs. 22.50 +/- 21.98 days respectively). 61.5% patients obtained a CR, 12.8% a PR, 10.3% a PD and 2.6% SD, without differences for type of nutrition. A trend toward shorter PFS in pts treated with PN vs. EN (57.3 vs not reached, p = 0.283) has been observed. Conclusions: Nutritional support with enteral nutrition during CRT for head and neck cancer might guarantee a better outcome in terms of nutritional status, treatment tolerance and PFS.