Languis et al evaluated weight loss in patients with head and neck cancer undergoing radiation therapy with or without chemotherapy. They identified factors associated with a critical weight loss during the radiation therapy period. The authors are from VU University, The Hague University of Applied Sciences and the Amsterdam University of Applied Sciences in The Netherlands.
Patient selection: head and neck cancer, radiation therapy with or without chemotherapy. WHO performance status 0 to 3
Critical weight loss was defined as > 5% during radiation therapy. This places the patient at increased risk for malnutrition and worse outcomes.
Duration of radiation therapy: 6-7 weeks with 5-6 fractions per week, total dose 56-70 Gy
Risk factors for critical weight loss in multivariate logistic regression model:
(1) radiation therapy to neck lymph nodes (unilateral odds ratio 3.2, bilateral odds ratio 4.1)
(2) radiotherapy dose to primary tumor >= 65 Gray (odds ratio 2.1)
(3) RT technique 3D (versus IMRT, odds ratio 1.7)
(4) WHO performance status 2 or 3 (odds ratio 0.55)
(5) age per 10 years, odds ratio 0.84
Parameters for prediction tree:
(1) RT to neck
(2) RT dose to primary tumour
(3) age in years
(4) RT technique (3D-RT = three dimensional confocal; IMRT = intensity-modulated radiotherapy)
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RT Neck
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RT Dose
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Age
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RT Technique
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Percent Critical Weight Loss
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No
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NA
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NA
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NA
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23%
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Yes
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<= 65 Gy
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<= 56 years
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NA
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56%
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Yes
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<= 65 Gy
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> 56 years
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NA
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33%
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Yes
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> 65 Gy
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NA
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3D-RT
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66%
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Yes
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> 65 Gy
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NA
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IMRT
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54%
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