The changing landscape of head and neck cancer radiotherapy patients: is high-risk, prolonged feeding tube use indicative of on-treatment weight loss?

Nigel J. Anderson, James E. Jackson, Morikatsu Wada, Michal Schneider, Michael Poulsen, Maureen Rolfo, Maziar Fahandej, Hui Gan, Vincent Khoo

Research output: Contribution to journalArticleResearchpeer-review

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Abstract

Introduction: Precision radiotherapy relies heavily on optimal weight management. Our group previously developed a risk stratification model for patients at risk of prolonged feeding tube (FT) intervention. The study objective was to assess on-treatment weight loss according to stratified risk of prolonged FT use. Methods: One hundred and one (n = 101) definitive head and neck radiotherapy patients were included in this study. Patients were stratified into high risk (HRi: T-classification ≥ 3 with level 2 Nodal disease), high-intermediate risk (HIRi: T-classification ≥ 3 without level 2 Nodes) and low-intermediate risk (LIRi: T-classification < 3 with level 2 Nodes) of prolonged FT use. Demographic variables and on-treatment weight loss were evaluated according to risk status. Results: Oropharyngeal carcinoma (OPC) was present in a larger proportion in the LIRi cohort (HRi: 71%, HIRi: 52%, LIRi: 81%, P = 0.008). LIRi patients were more likely to have human papilloma virus (HPV)-associated disease (88%, P = 0.001). Never/minimal smoking (P = 0.003), good performance status (P < 0.001), healthy BMI (P = 0.050) and no pre-existing dysphagia (P < 0.001) were predominant within the LIRi prognostic group. LIRi patients lost significantly more weight in total (HRi = 4.8% vs. LIRi = 8.2%, P = 0.002; HIRi = 5.2% vs. LIRi = 8.2%, P = 0.006) and when using a FT (HRi = 4.6% vs. LIRi = 8.8%, P < 0.001; HIRi = 5.3% vs. LIRi = 8.8%, P = 0.002). Conclusions: Patients identified as low-intermediate risk of prolonged, ≥25% FT use report significantly increased weight loss compared with patients at higher risk of FT use. This cohort is typical of the increasing number of patients presenting with HPV-associated OPC. Results of this study suggest we should closely observe such patients throughout treatment, to ensure optimal weight maintenance, facilitating precision radiotherapy.

Original languageEnglish
Pages (from-to)250-258
Number of pages9
JournalJournal of Medical Radiation Sciences
Volume66
Issue number4
DOIs
Publication statusPublished - Aug 2019

Keywords

  • feeding tube
  • head and neck cancer
  • intensity modulated radiotherapy
  • toxicity
  • weight loss

Cite this

Anderson, Nigel J. ; Jackson, James E. ; Wada, Morikatsu ; Schneider, Michal ; Poulsen, Michael ; Rolfo, Maureen ; Fahandej, Maziar ; Gan, Hui ; Khoo, Vincent. / The changing landscape of head and neck cancer radiotherapy patients : is high-risk, prolonged feeding tube use indicative of on-treatment weight loss?. In: Journal of Medical Radiation Sciences. 2019 ; Vol. 66, No. 4. pp. 250-258.
@article{292335a48f3c416cafe5014914cece55,
title = "The changing landscape of head and neck cancer radiotherapy patients: is high-risk, prolonged feeding tube use indicative of on-treatment weight loss?",
abstract = "Introduction: Precision radiotherapy relies heavily on optimal weight management. Our group previously developed a risk stratification model for patients at risk of prolonged feeding tube (FT) intervention. The study objective was to assess on-treatment weight loss according to stratified risk of prolonged FT use. Methods: One hundred and one (n = 101) definitive head and neck radiotherapy patients were included in this study. Patients were stratified into high risk (HRi: T-classification ≥ 3 with level 2 Nodal disease), high-intermediate risk (HIRi: T-classification ≥ 3 without level 2 Nodes) and low-intermediate risk (LIRi: T-classification < 3 with level 2 Nodes) of prolonged FT use. Demographic variables and on-treatment weight loss were evaluated according to risk status. Results: Oropharyngeal carcinoma (OPC) was present in a larger proportion in the LIRi cohort (HRi: 71{\%}, HIRi: 52{\%}, LIRi: 81{\%}, P = 0.008). LIRi patients were more likely to have human papilloma virus (HPV)-associated disease (88{\%}, P = 0.001). Never/minimal smoking (P = 0.003), good performance status (P < 0.001), healthy BMI (P = 0.050) and no pre-existing dysphagia (P < 0.001) were predominant within the LIRi prognostic group. LIRi patients lost significantly more weight in total (HRi = 4.8{\%} vs. LIRi = 8.2{\%}, P = 0.002; HIRi = 5.2{\%} vs. LIRi = 8.2{\%}, P = 0.006) and when using a FT (HRi = 4.6{\%} vs. LIRi = 8.8{\%}, P < 0.001; HIRi = 5.3{\%} vs. LIRi = 8.8{\%}, P = 0.002). Conclusions: Patients identified as low-intermediate risk of prolonged, ≥25{\%} FT use report significantly increased weight loss compared with patients at higher risk of FT use. This cohort is typical of the increasing number of patients presenting with HPV-associated OPC. Results of this study suggest we should closely observe such patients throughout treatment, to ensure optimal weight maintenance, facilitating precision radiotherapy.",
keywords = "feeding tube, head and neck cancer, intensity modulated radiotherapy, toxicity, weight loss",
author = "Anderson, {Nigel J.} and Jackson, {James E.} and Morikatsu Wada and Michal Schneider and Michael Poulsen and Maureen Rolfo and Maziar Fahandej and Hui Gan and Vincent Khoo",
year = "2019",
month = "8",
doi = "10.1002/jmrs.349",
language = "English",
volume = "66",
pages = "250--258",
journal = "Journal of Medical Radiation Sciences",
issn = "2051-3895",
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The changing landscape of head and neck cancer radiotherapy patients : is high-risk, prolonged feeding tube use indicative of on-treatment weight loss? / Anderson, Nigel J.; Jackson, James E.; Wada, Morikatsu; Schneider, Michal; Poulsen, Michael; Rolfo, Maureen; Fahandej, Maziar; Gan, Hui; Khoo, Vincent.

In: Journal of Medical Radiation Sciences, Vol. 66, No. 4, 08.2019, p. 250-258.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - The changing landscape of head and neck cancer radiotherapy patients

T2 - is high-risk, prolonged feeding tube use indicative of on-treatment weight loss?

AU - Anderson, Nigel J.

AU - Jackson, James E.

AU - Wada, Morikatsu

AU - Schneider, Michal

AU - Poulsen, Michael

AU - Rolfo, Maureen

AU - Fahandej, Maziar

AU - Gan, Hui

AU - Khoo, Vincent

PY - 2019/8

Y1 - 2019/8

N2 - Introduction: Precision radiotherapy relies heavily on optimal weight management. Our group previously developed a risk stratification model for patients at risk of prolonged feeding tube (FT) intervention. The study objective was to assess on-treatment weight loss according to stratified risk of prolonged FT use. Methods: One hundred and one (n = 101) definitive head and neck radiotherapy patients were included in this study. Patients were stratified into high risk (HRi: T-classification ≥ 3 with level 2 Nodal disease), high-intermediate risk (HIRi: T-classification ≥ 3 without level 2 Nodes) and low-intermediate risk (LIRi: T-classification < 3 with level 2 Nodes) of prolonged FT use. Demographic variables and on-treatment weight loss were evaluated according to risk status. Results: Oropharyngeal carcinoma (OPC) was present in a larger proportion in the LIRi cohort (HRi: 71%, HIRi: 52%, LIRi: 81%, P = 0.008). LIRi patients were more likely to have human papilloma virus (HPV)-associated disease (88%, P = 0.001). Never/minimal smoking (P = 0.003), good performance status (P < 0.001), healthy BMI (P = 0.050) and no pre-existing dysphagia (P < 0.001) were predominant within the LIRi prognostic group. LIRi patients lost significantly more weight in total (HRi = 4.8% vs. LIRi = 8.2%, P = 0.002; HIRi = 5.2% vs. LIRi = 8.2%, P = 0.006) and when using a FT (HRi = 4.6% vs. LIRi = 8.8%, P < 0.001; HIRi = 5.3% vs. LIRi = 8.8%, P = 0.002). Conclusions: Patients identified as low-intermediate risk of prolonged, ≥25% FT use report significantly increased weight loss compared with patients at higher risk of FT use. This cohort is typical of the increasing number of patients presenting with HPV-associated OPC. Results of this study suggest we should closely observe such patients throughout treatment, to ensure optimal weight maintenance, facilitating precision radiotherapy.

AB - Introduction: Precision radiotherapy relies heavily on optimal weight management. Our group previously developed a risk stratification model for patients at risk of prolonged feeding tube (FT) intervention. The study objective was to assess on-treatment weight loss according to stratified risk of prolonged FT use. Methods: One hundred and one (n = 101) definitive head and neck radiotherapy patients were included in this study. Patients were stratified into high risk (HRi: T-classification ≥ 3 with level 2 Nodal disease), high-intermediate risk (HIRi: T-classification ≥ 3 without level 2 Nodes) and low-intermediate risk (LIRi: T-classification < 3 with level 2 Nodes) of prolonged FT use. Demographic variables and on-treatment weight loss were evaluated according to risk status. Results: Oropharyngeal carcinoma (OPC) was present in a larger proportion in the LIRi cohort (HRi: 71%, HIRi: 52%, LIRi: 81%, P = 0.008). LIRi patients were more likely to have human papilloma virus (HPV)-associated disease (88%, P = 0.001). Never/minimal smoking (P = 0.003), good performance status (P < 0.001), healthy BMI (P = 0.050) and no pre-existing dysphagia (P < 0.001) were predominant within the LIRi prognostic group. LIRi patients lost significantly more weight in total (HRi = 4.8% vs. LIRi = 8.2%, P = 0.002; HIRi = 5.2% vs. LIRi = 8.2%, P = 0.006) and when using a FT (HRi = 4.6% vs. LIRi = 8.8%, P < 0.001; HIRi = 5.3% vs. LIRi = 8.8%, P = 0.002). Conclusions: Patients identified as low-intermediate risk of prolonged, ≥25% FT use report significantly increased weight loss compared with patients at higher risk of FT use. This cohort is typical of the increasing number of patients presenting with HPV-associated OPC. Results of this study suggest we should closely observe such patients throughout treatment, to ensure optimal weight maintenance, facilitating precision radiotherapy.

KW - feeding tube

KW - head and neck cancer

KW - intensity modulated radiotherapy

KW - toxicity

KW - weight loss

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U2 - 10.1002/jmrs.349

DO - 10.1002/jmrs.349

M3 - Article

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EP - 258

JO - Journal of Medical Radiation Sciences

JF - Journal of Medical Radiation Sciences

SN - 2051-3895

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