Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Sep 3;109(5):1093-9.
doi: 10.1038/bjc.2013.458. Epub 2013 Aug 8.

Critical weight loss is a major prognostic indicator for disease-specific survival in patients with head and neck cancer receiving radiotherapy

J A E Langius  1 , S Bakker, D H F Rietveld, H M Kruizenga, J A Langendijk, P J M Weijs, C R Leemans
Affiliations

Critical weight loss is a major prognostic indicator for disease-specific survival in patients with head and neck cancer receiving radiotherapy

J A E Langius et al. Br J Cancer. .

Abstract

Background: Pre-treatment weight loss (WL) is a prognostic indicator for overall survival (OS) in head and neck cancer (HNC) patients. This study investigates the association between WL before or during radiotherapy and disease-specific survival (DSS) in HNC patients.

Methods: In 1340 newly diagnosed HNC patients, weight change was collected before and during (adjuvant) radiotherapy with curative intent. Critical WL during radiotherapy was defined as >5% WL during radiotherapy or >7.5% WL until week 12. Differences in 5-year OS and DSS between WL groups were analysed by Cox's regression with adjustments for important socio-demographic and tumour-related confounders.

Results: Before radiotherapy, 70% of patients had no WL, 16% had ≤5% WL, 9% had >5-10% WL, and 5% had >10% WL. Five-year OS and DSS rates for these groups were 71%, 59%, 47%, and 42% (P<0.001), and 86%, 86%, 81%, and 71%, respectively (P<0.001). After adjustment for potential confounders, >10% WL before radiotherapy remained significantly associated with a worse OS (HR 1.7; 95% CI 1.2-2.5; P=0.002) and DSS (HR 2.1; 95% CI 1.2-3.5; P=0.007).The 5-year OS and DSS rates for patients with critical WL during radiotherapy were 62% and 82%, compared with 70% and 89% for patients without critical WL (P=0.01; P=0.001). After adjustment, critical WL during radiotherapy remained significantly associated with a worse DSS (HR 1.7; 95% CI 1.2-2.4; P=0.004).

Conclusion: Weight loss both before and during radiotherapy are important prognostic indicators for 5-year DSS in HNC patients. Randomised studies into the prognostic effect of nutritional intervention are needed.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flowchart.
Figure 2
Figure 2
Kaplan–Meier survival plot of overall survival by weight loss category before radiotherapy (log-rank test: P<0.001).
Figure 3
Figure 3
Kaplan–Meier survival plot of disease-specific survival by weight loss during radiotherapy (log-rank test: P=0.001).
See this image and copyright information in PMC

References

    1. Argiris A, Li Y, Forastiere A. Prognostic factors and long-term survivorship in patients with recurrent or metastatic carcinoma of the head and neck. Cancer. 2004;101:2222–2229. - PubMed
    1. Baracos VE. Cancer-associated cachexia and underlying biological mechanisms. Annu Rev Nutr. 2006;26:435–461. - PubMed
    1. Brookes GB. Nutritional status-a prognostic indicator in head and neck cancer. Otolaryngol Head Neck Surg. 1985;93:69–74. - PubMed
    1. Capuano G, Gentile PC, Bianciardi F, Tosti M, Palladino A, Di PM. Prevalence and influence of malnutrition on quality of life and performance status in patients with locally advanced head and neck cancer before treatment. Support Care Cancer. 2010;18:433–437. - PubMed
    1. Capuano G, Grosso A, Gentile PC, Battista M, Bianciardi F, Di PA, Pavese I, Satta F, Tosti M, Palladino A, Coiro G, Di PM. Influence of weight loss on outcomes in patients with head and neck cancer undergoing concomitant chemoradiotherapy. Head Neck. 2008;30:503–508. - PubMed