Impact of weight loss on survival after chemoradiation for locally advanced head and neck cancer: secondary results of a randomized phase III trial (SAKK 10/94)

Pirus Ghadjar, Stefanie Hayoz, Frank Zimmermann, Stephan Bodis, David Kaul, Harun Badakhshi, Jacques Bernier, Gabriela Studer, Ludwig Plasswilm, Volker Budach, Daniel M Aebersold, Swiss Group for Clinical Cancer Research (SAKK), Pirus Ghadjar, Stefanie Hayoz, Frank Zimmermann, Stephan Bodis, David Kaul, Harun Badakhshi, Jacques Bernier, Gabriela Studer, Ludwig Plasswilm, Volker Budach, Daniel M Aebersold, Swiss Group for Clinical Cancer Research (SAKK)

Abstract

Background: To analyze the impact of weight loss before and during chemoradiation on survival outcomes in patients with locally advanced head and neck cancer.

Methods: From 07/1994-07/2000 a total of 224 patients with squamous cell carcinoma of the head and neck were randomized to either hyperfractionated radiation therapy alone or the same radiation therapy combined with two cycles of concomitant cisplatin. The primary endpoint was time to any treatment failure (TTF); secondary endpoints were locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS) and overall survival (OS). Patient weight was measured 6 months before treatment, at treatment start and treatment end.

Results: The proportion of patients with >5% weight loss was 32% before, and 51% during treatment, and the proportion of patients with >10% weight loss was 12% before, and 17% during treatment. After a median follow-up of 9.5 years (range, 0.1 - 15.4 years) weight loss before treatment was associated with decreased TTF, LRRFS, DMFS, cancer specific survival and OS in a multivariable analysis. However, weight loss during treatment was not associated with survival outcomes.

Conclusions: Weight loss before and during chemoradiation was commonly observed. Weight loss before but not during treatment was associated with worse survival.

Figures

Figure 1
Figure 1
Kaplan Meier plots showing patients with weight loss before and during treatment and time to any treatment failure (A,B) locoregional failure-free survival (C,D) and distant metastasis-free survival (E,F) over 9.5 years median follow-up stratified according to the magnitude of weight loss.
Figure 2
Figure 2
Kaplan Meier plots showing patients with weight loss before and during treatment and cancer specific survival (A,B) and overall survival (C,D) over 9.5 years median follow-up stratified according to the magnitude of weight loss.

References

    1. Ghadjar P, Simcock M, Studer G, Allal AS, Ozsahin M, Swiss Group for Clinical Cancer Research (SAKK) et al. Concomitant cisplatin and hyperfractionated radiotherapy in locally advanced head and neck cancer: 10-year follow-up of a randomized phase III trial (SAKK 10/94) Int J Radiat Oncol Biol Phys. 2012;82:524–31. doi: 10.1016/j.ijrobp.2010.11.067.
    1. Van Den Broek GB, Rasch CR, Pameijer FA, Peter E, van den Brekel MW, Tan IB, et al. Pretreatment probability model for predicting outcome after intraarterial chemoradiation for advanced head and neck carcinoma. Cancer. 2004;101:1809–17. doi: 10.1002/cncr.20556.
    1. Langius JAE, Bakker S, Rietveld DHF, Kruizenga HM, Langendijk JA, Weijs PJ, et al. Critical weight loss is a major prognostic indicator for disease-specific survival in patients with head and neck cancer receiving radiotherapy. Brit J Cancer. 2013;109:1093–9. doi: 10.1038/bjc.2013.458.
    1. Pai PC, Chuang CC, Tseng CK, Tsang NM, Chang KP, Yen TC, et al. Impact of pretreatment body mass index on patients with head-and-neck cancer treated with radiation. Int J Radiat Oncol Biol Phys. 2012;83:e93–100. doi: 10.1016/j.ijrobp.2011.11.071.
    1. Cho YW, Roh JL, Jung JH, Kim SB, Lee SW, Choi SH, et al. Prediction of posttreament significant body weight loss and its correlation with disease-free survival in patients with oral squamous cell carcinomas. Nutr Cancer. 2013;65:417–23. doi: 10.1080/01635581.2013.767365.
    1. White JV, Guenter P, Jensen G, Malone A, Schofield M. Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition) JPEN J Parenter Enteral Nutr. 2012;36:275–83. doi: 10.1177/0148607112440285.
    1. Park SM, Lim MK, Shin SA, Yun YH. Impact of prediagnosis smoking, alcohol, obesity, and insulin resistance on survival in male cancer patients: national health insurance corporation study. J Clin Oncol. 2006;24:5017–24. doi: 10.1200/JCO.2006.07.0243.
    1. Rabinovitch R, Grant B, Berkey BA, Raben D, Ang KK, Fu KK, et al. Impact of nutrition support on treatment outcome in patients with locally advanced head and neck squamous cell cancer treated with definitive radiotherapy: a secondary analysis of RTOG trial 90–03. Head Neck. 2006;28:287–96. doi: 10.1002/hed.20335.

Source: PubMed

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