Head and Neck Cancer
PV QA 2 - Poster Viewing Q&A 2
Purpose/Objective(s):The purpose of this study was to investigate the influence of neoadjuvant chemotherapy (NACT) combined with concurrent chemoradiotherapy (CCRT) on nutritional status in patients with locoregionally advanced nasopharyngeal carcinoma (LANPC).
Materials/Methods:This is a prospective, non-interventional, multicenter study. Patients were recruited from ten hospitals in China with the key inclusion criteria of untreated LANPC. All eligible patients received NACT with docetaxel (75mg/m2) and cisplatin (75mg/m2) once every 3 weeks for 2 cycles, followed by CCRT with cisplatin (100mg/m2) and intensity-modulated radiotherapy. Nutrition related parameters including weight loss (WL), body mass index (BMI), the score of Nutrition Risk Screening 2002 (NRS2002) and Patient-Generated Subjective Global Assessment (PG-SGA), and Quality of life (QoL) score (EORTC QLQ-C30), acute toxicities (CTCAE v4.0), treatment compliance were recorded before, during, and after treatment. Statistical analyses are using SPSS 22.0. The study was registered on ClinicalTrials.gov, number NCT02575547.
Results:From Jun 2015 to Nov 2016, we enrolled 186 patients, of whom 171 were eligible for analysis. The overall incidence of mild and severe malnutrition was 68.5% and 37.4%, respectively. The incidence of nutritional related parameters and the average QoL score on each observation point were shown in Table 1. During the treatment, patients with ≥ 2 grade oral mucositis have higher risks of WL ≥ 10% (P = 0.037), NRS2002 ≥ 3 points (P = 0.002) and PG-SGA ≥ 9 points (P < 0.001). 97.7% and 87.7% patients finished NACT and CCRT, respectively, and 99.4% patients finished radiotherapy. Patients with PG-SGA ≥ 9 points and C30-QoL < 50 points had poor chemotherapy compliance (P = 0.014 and P < 0.001), and patients with BMI < 18.5 had poor radiotherapy compliance (P = 0.036).
Conclusion:Malnutrition was prevalent in LANPC patients treated with NACT plus CCRT, and mainly occurred in CCRT period, even lasted until 1 year after treatment in some patients. Furthermore, its impact on clinical outcomes need long-term follow-up. Table 1 Incidence of nutrition related parameters and the average quality of life score on each observation points
|prior NACT||after 1 cycle NACT||prior RT||4th week of RT||end of RT||3 months after RT||1 year after RT|
|WL ≥ 5% (mild malnutrition)||5.3%||6.0%||5.4%||38.7%||68.5%||64.1%||54.1%|
|WL ≥ 10% (severe malnutrition)||0||1.8%||1.8%||7.7%||33.3%||37.4%||28.4%|
|BMI < 18.5||5.8%||7.1%||6.5%||12.5%||19.4%||16.8%||13.5%|
|NRS2002 ≥ 3 points (high risk of malnutrition)||8.2%||-||6.9%||54.4%||79.4%||10.9%||6.7%|
|PG-SGA ≥ 4 points (need nutrition treatment)||16.8%||-||23.6%||96.7%||96.6%||38.3%||12.2%|
|PG-SGA ≥ 9 points (need nutrition treatment urgently)||3.0%||-||3.9%||72.0%||76.6%||6.3%||0|
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