Head & neck cancer patients treated with radical/adjuvant radiotherapy suffer from weight loss, the cause of which can be multifactorial. In this study we have evaluated weight loss pattern in H&N cancer patients receiving either conventional or conformal chemoradiotherapy (CCRT)/adjuvant radiotherapy (RT) and to find out possible factors.
A retrospective study was done using data of already treated head & neck cancer patients. Inclusion criteria- 1) Primary site: oral cavity, oropharynx, larynx, & hypopharynx. 2) Treated with either radical CCRT(with Inj. Cisplatin) or adjuvant RT. Exclusion criteria- 1) palliative radiotherapy, 2)treatment gap >6 days. Basic parameters were collected, weight at beginning & at end of Radiotherapy noted. As general rule, Ryle’s tube insertion was done only when needed (difficulty to swallow liquid).
160 patients’ data were collected: 80 patients- Conformal RT (40 patients radical CCRT & 40 patients adjuvant RT), 80 patients- Conventional RT (40 patients radical CCRT & 40 patients adjuvant RT). Only 5 patients (2 conformal CCRT & 3 conformal RT) out of total 160 patients gained weight during course of RT. Hence, 155 patients suffered weight loss. We compared variables with absolute weight loss of ≤ 5kg & >5kg using Chi square (χ2) test. Also, variables were compared with relative weight loss of ≤ 10% & >10%. The variables affecting both absolute and relative weight loss were initial low KPS status, use of conventional RT technique and use of chemotherapy & higher radiation dose (>60Gy). It was also found that ryle’s tube insertion was significantly more in patients with >5kg/>10% weight loss. Variables affecting absolute and relative weight loss: χ2 Assessment (P Value) (* indicates significant)Variables ≤ 5kg vs. >5kg (n = 118) (n = 37) ≤10% vs. >10% (n = 94) (n = 61) Gender (male vs. female) 0.508 0.801 Age (≤50 years vs. >50 years) 0.644 0.421 KPS (<80 vs. ≥80) <0.001* <0.001* Site(Oral Cavity vs. Oropharynx vs. Larynx&Hypopharynx) 0.546 0.413 Indication & Dose (Radical CCRT- 66Gy vs. Adjuvant RT- 60Gy) 0.005* 0.038* RT Technique (Conventional vs. Conformal) 0.009* 0.001*
Weight loss in H&N cancer patients during CCRT/RT is expected. Conformal RT (which corresponds to reduced treatment volume & toxicities), better KPS status can limit the extent of weight loss. Addition of chemotherapy and higher radiation dose (>60Gy) will increase weight loss. Ryle’s tube insertion as prophylaxis may be considered, specially in patients with expected weight loss >5kg/>10%.
Subhadip Das, Debarshi Lahiri, Syamsundar Mandal, Priyanka Biswas.
Has not received any funding.
All authors have declared no conflicts of interest.