Weight loss in patients with head and neck cancer during and after conventional and accelerated radiotherapy

Abstract

Background. Weight loss is common among patients with squamous cell carcinoma of the head and neck (SCCHN) and is mainly due to tumor and treatment related factors. The aim of the present study was to evaluate weight loss in patients with SCCHN undergoing two different radiotherapy (RT) schedules. Material and methods. Nutritional data were analyzed from the ARTSCAN study, a controlled randomized prospective Swedish multicenter study conducted with the aim of comparing conventional fractionation (2.0 Gy per day, total 68 Gy during 7 weeks) and accelerated fractionation (1.1 + 2.0 Gy per day, total 68 Gy during 4.5 weeks). Seven hundred and fifty patients were randomized and 712 patients were followed from the start of RT in the present nutritional study. Results. The patients had a weight loss of 11.3% (± 8.6%) during the acute phase (start of RT up to five months after the termination of RT). No difference in weight loss was seen between the two RT fractionation schedules (p = 0.839). Three factors were significantly predictive for weight loss during the acute phase, i.e. tumor site, overweight/obesity or lack of tube feeding at the start of RT. Moreover, the nadir point of weight loss occurred at five months after the termination of RT. Conclusion. The results of the present study showed no difference in weight loss between the two RT fractionation schedules and also highlight that weight loss in SCCHN is a multifactorial problem. Moreover, the nadir of weight loss occurred at five months after the termination of treatment which calls for more intense nutritional interventions during the period after treatment.

Acknowledgements

The study was made possible by the commitment from the staff at the participating centers in the ARTSCAN study – Umeå University Hospital, Lund University Hospital, Karolinska University Hospital at Solna and at Huddinge, Stockholm, Sahlgrenska University Hospital, Göteborg, Örebro University Hospital, Malmö University Hospital, Karlstad Central Hospital, Linköping University Hospital, Gävle Hospital, Ryhov County Hospital, Jönköping, and Uppsala University Hospital. The authors acknowledge Ove Björ for statistical advice.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

This study was supported by grants from the Swedish Cancer Society, Laryngfonden (Sweden), Lions Cancer Research Foundation at Umeå University and the Cancer Research Foundation of Northern Sweden. The study sponsors had no role in the study design, data collection, analysis and writing or in the decision to submit the manuscript.