Dosimetric impact of weight loss and anatomical changes at organs at risk during intensity-modulated radiotherapy for head-and-neck cancer (original) (raw)
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Cancers, 2021
Delivered radiation dose can differ from intended dose. This study quantifies dose deterioration in targets, identifies predictive factors, and compares dosimetric to clinical patient selection for adaptive radiotherapy in head-and-neck cancer patients. One hundred and eighty-eight consecutive head-and-neck cancer patients treated up to 70 Gy were analyzed. Daily delivered dose was calculated, accumulated, and compared to the planned dose. Cutoff values (1 Gy/2 Gy) were used to assess plan deterioration in the highest/lowest dose percentile (D1/D99). Differences in clinical factors between patients with/without dosimetric deterioration were statistically tested. Dosimetric deterioration was evaluated in clinically selected patients for adaptive radiotherapy with CBCT. Respectively, 16% and 4% of patients had deterioration over 1 Gy in D99 and D1 in any of the targets, this was 5% (D99) and 2% (D1) over 2 Gy. Factors associated with deterioration of D99 were higher baseline weight/BM...
https://www.ijrrjournal.com/IJRR\_Vol.6\_Issue.6\_June2019/Abstract\_IJRR002.html, 2019
Purpose: Weight loss is common among patients with squamous cell carcinoma of the head and neck during chemo-radiotherapy and may be due to multiple tumor and treatment related factors. The aim of the present study was to evaluate factors associated with weight loss during radiotherapy treatment of head and neck cancers. Methods: One hundred one patients of squamous cell carcinoma of head and neck treated with concurrent chemoradiation or postoperative radiotherapy were evaluated in this analysis. Major head and neck subsites including Oropharynx, Oral cavity Hypopharynx and Nasopharynx were included in the analysis. A dose of 66-70Gy was given in the radical chemoradiation schedule. In postoperative radiotherapy, a dose of 60-64Gy was delivered. Patients were treated with two-field or three field conventional radiation techniques. Patient's weight was evaluated before, weekly during treatment and after completion of treatment to evaluate weight loss trends. Weight loss grading was done as per CTCAE v3. Results: Analysis was done to see which factors were causative in patients having a grade 1(5-10%) and grade 2(>10%) weight loss. Three variables were found to be significant for >5% weight loss. These were a tumor located in base of tongue (p < 0.007), use of chemoradiation (p<0.013), and a total dose of > 60 Gy (p<0.012). Other factors like trismus (p<0.063) and xerostomia (p<0.060) also showed trend towards significance. No difference was observed in patients with weekly or 3 weekly chemo-radiation schedules. Conclusion: Our study shows that base of tongue cancers on chemoradiation had significant weight loss compared to other head and neck subsites. Radiation doses over 60 Gy is another significant factor for weight loss.
Pattern of weight loss in head and neck cancer patients undergoing curative radiotherapy
International journal of applied research, 2016
Many patients receiving fractionated radiotherapy (RT) for head-and-neck cancer have marked anatomic changes during their course of treatment. The aim of this study was to investigate the incidence of weight loss in head and neck cancer patients after the commencement of radiotherapy treatment. Methods and Materials: A total of 30 patients with head and neck cancer treated with Intensity modulated radiotherapy was enrolled in the study. The weight of patient every week was documented and percentage drop from the baseline was observed. Results: The mean weight at baseline was 54.50 kg and the mean weight at the end of 6 weeks of radiotherapy was 51.10 kg. The percentage drop in weight was 6.57%. A significant number of patients experienced a dry mouth, had difficulty masticating and swallowing food, had altered taste perception, were missing meals. Conclusion: Since radiotherapy treatment may further limit oral intake, it is essential that dietetic intervention is addressed for all head and neck cancer patients and incorporated into the treatment plan on diagnosis.
Predictors of weight loss during radiotherapy in patients with stage I or II head and neck cancer
Cancer, 2010
BACKGROUND: The purpose of the study was to identify predictors of weight loss during radiotherapy (RT) in patients with stage I or II head and neck (HN) cancer. METHODS: This study was conducted as part of a phase 3 chemoprevention trial. A total of 540 patients were randomized. The patients were weighed before and after RT. Their baseline characteristics, including lifestyle habits, diet, and quality of life, were assessed as potential predictors. Predictors were identified using multiple linear regressions. The reliability of the model was assessed by bootstrap resampling. A receiver operating characteristics curve was generated to estimate the model's accuracy in predicting critical weight loss (!5%). RESULTS: The mean weight loss was 2.2 kg (standard deviation, 3.4). Five factors were associated with a greater weight loss: all HN cancer sites other than the glottic larynx (P<.001), higher pre-RT body weight (P<.001), stage II disease (P ¼ .002), dysphagia and/or odynophagia before RT (P ¼ .001), and a lower Karnofsky performance score (P ¼ .028). There was no association with pre-RT lifestyle habits, diet, or quality of life. The bootstrapping method confirmed the reliability of this predictive model. The area under the curve was 71.3% (95% confidence interval, 65.8-76.9), which represents an acceptable ability of the model to predict critical weight loss. CONCLUSIONS: These results could be useful to clinicians for screening patients with early stage HN cancer treated by RT who require special nutritional attention. Cancer 2010;116:2275-83.
Supportive Care in Cancer, 2015
Purpose The aims of the present study were to explore pretreatment predictors of weight loss during radiation treatment only in head and neck cancer (HNSCC) patients and investigate the weight loss in patients with or without a feeding tube. Methods Retrospectively, weight change during curative radiotherapy was investigated in 476 consecutive HNSCC patients. Independent predictors were identified using multivariate regression analysis with weight loss below or above 5 % as the primary dependent variable. Results Baseline BMI, tumor site, and stage predicted weight loss above 5 %. The odds of weight loss above 5 % in patients with BMI >25 were 3.00±0.64 times higher compared with patients with BMI <25 (p<0.0001). Patients with pharyngeal, oral cavity, or supraglottic tumors had 3.12±0.80 times higher odds of weight loss above 5 % compared with glottic cancer patients (p<0.0001), and the odds were 1.68±0.40 times higher in stage III-IV patients compared with stage I-II patients (p=0.03). Seperate analyses revealed that tumor site and stage only predicted weight loss in patients with BMI >25 but not in patients with BMI <25. Patients receiving a feeding tube weighed less than patients without (73.8 vs 78.3 kg) and feeding tube reduced, but did not prevent, weight loss which averaged 6.7±4.7 kg (7.4±4.7 %) compared with 4.7 ± 5.9 kg (5.5 ± 6.0 %) in patients without a feeding tube (P<0.0001). Conclusion Pre-treatment BMI, tumor site and stage predicted weight loss above 5 % in HNSCC patients during radiotherapy. BMI should be considered when analyzing weight loss in HNSCC patients receiving curative radiotherapy.
A bioimpedance analysis of head-and-neck cancer patients undergoing radiotherapy
Current Oncology
Malnutrition is a frequent manifestation in patients with head-and-neck cancer undergoing radiation therapy and a major contributor to morbidity and mortality. Thus, body composition is an important component of an overall evaluation of nutrition in cancer patients. Malnutrition is characterized by weight loss, loss of muscle mass, changes in cell membrane integrity, and alterations in fluid balance. Bioelectrical impedance analysis is a method to analyze body composition and includes parameters such as intracellular water content, extracellular water content, and cell membrane integrity in the form of a phase angle (Φ). Bioelectrical impedance analysis has consistently been shown to have prognostic value with respect to mortality and morbidity in patients undergoing chemotherapy. The goal of the present study was to evaluate the relationship between Φ, time, intracellular water content, and weight for head-and-neck cancer patients undergoing radiotherapy. The results demonstrate th...
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2015
In the last decade, many efforts have been made to characterize anatomic changes of head and neck organs at risk (OARs) and the dosimetric consequences during radiotherapy. This review was undertaken to provide an overview of the magnitude and frequency of these effects, and to investigate whether we could find criteria to identify head and neck cancer patients who may benefit from adaptive radiotherapy (ART). Possible relationships between anatomic and dosimetric changes and outcome were explicitly considered. A literature search according to PRISMA guidelines was performed in MEDLINE and EMBASE for studies concerning anatomic or dosimetric changes of head and neck OARs during radiotherapy. Fifty-one eligible studies were found. The majority of papers reported on parotid gland (PG) anatomic and dosimetric changes. In some patients, PG mean dose differences between planning CT and repeat CT scans up to 10Gy were reported. In other studies, only minor dosimetric effects (i.e. <1Gy...