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Title: The changing landscape of head and neck cancer radiotherapy patients: is high-risk, prolonged feeding tube use indicative of on-treatment weight loss?
Austin Authors: Anderson, Nigel J;Jackson, James E;Wada, Morikatsu ;Schneider, Michal;Poulsen, Michael;Rolfo, Maureen;Fahandej, Maziar;Gan, Hui K ;Khoo, Vincent
Affiliation: Department of Palliative Care, St Vincent's Hospital, Fitzroy, Victoria, Australia
School of Cancer Medicine, La Trobe University School of Cancer Medicine, Melbourne, Victoria, Australia
Medical Oncology
Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
Radiation Oncology
Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
Radiation Oncology Centres, Gold Coast University Hospital, Gold Coast, Queensland, Australia
Department of Clinical Oncology, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Chelsea, London, UK
Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
School of Medicine, Griffith University, Gold Coast, Queensland, Australia
Department of Medical Imaging and Radiation Sciences, Monash University, Monash, Victoria, Australia
Olivia Newton-John Cancer Research Institute, Heidelberg, Victoria, Australia
Issue Date: Dec-2019
Date: 2019-08-06
Publication information: Journal of Medical Radiation Sciences 2019; 66(4): 250-258
Abstract: Precision radiotherapy relies heavily on optimal weight management. Our group previously developed a risk stratification model for patients at risk of prolonged feeding tube (FT) intervention. The study objective was to assess on-treatment weight loss according to stratified risk of prolonged FT use. One hundred and one (n = 101) definitive head and neck radiotherapy patients were included in this study. Patients were stratified into high risk (HRi: T-classification ≥ 3 with level 2 Nodal disease), high-intermediate risk (HIRi: T-classification ≥ 3 without level 2 Nodes) and low-intermediate risk (LIRi: T-classification < 3 with level 2 Nodes) of prolonged FT use. Demographic variables and on-treatment weight loss were evaluated according to risk status. Oropharyngeal carcinoma (OPC) was present in a larger proportion in the LIRi cohort (HRi: 71%, HIRi: 52%, LIRi: 81%, P = 0.008). LIRi patients were more likely to have human papilloma virus (HPV)-associated disease (88%, P = 0.001). Never/minimal smoking (P = 0.003), good performance status (P < 0.001), healthy BMI (P = 0.050) and no pre-existing dysphagia (P < 0.001) were predominant within the LIRi prognostic group. LIRi patients lost significantly more weight in total (HRi = 4.8% vs. LIRi = 8.2%, P = 0.002; HIRi = 5.2% vs. LIRi = 8.2%, P = 0.006) and when using a FT (HRi = 4.6% vs. LIRi = 8.8%, P < 0.001; HIRi = 5.3% vs. LIRi = 8.8%, P = 0.002). Patients identified as low-intermediate risk of prolonged, ≥25% FT use report significantly increased weight loss compared with patients at higher risk of FT use. This cohort is typical of the increasing number of patients presenting with HPV-associated OPC. Results of this study suggest we should closely observe such patients throughout treatment, to ensure optimal weight maintenance, facilitating precision radiotherapy.
DOI: 10.1002/jmrs.349
ORCID: 0000-0002-4826-2339
Journal: Journal of Medical Radiation Sciences
PubMed URL: 31385650
Type: Journal Article
Subjects: feeding tube
head and neck cancer
intensity modulated radiotherapy
weight loss
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