Concurrent Chemoradiotherapy Induces Body Composition Changes in Locally Advanced Head and Neck Squamous Cell Carcinoma: Comparison between Oral Cavity and Non-Oral Cavity Cancer

Yu-Ching Lin,Wen-Chi Chou,Cheng-Hsu Wang,Kun-Yun Yeh,Fang-Ping Chen,Pei-Hung Chang,Yi-Ping Pan,Hang Huong Ling

doi:10.3390/nu13092969

Abstract

Few prospective cohort trials have evaluated the difference in treatment-interval total body composition (TBC) changes assessed by dual-energy X-ray absorptiometry (DXA) between two patient subgroups with locally advanced head and neck squamous cell carcinoma (LAHNSCC) receiving concurrent chemoradiotherapy (CCRT): oral cavity cancer with adjuvant CCRT (OCC) and non-oral cavity with primary CCRT (NOCC). This study prospectively recruited patients with LAHNSCC. Clinicopathological variables, blood nutritional/inflammatory markers, CCRT-related factors, and TBC data assessed by DXA before and after treatment were collected. Multivariate linear regression analysis identified the factors associated with treatment-interval changes in body composition parameters, including lean body mass (LBM), total fat mass (TFM), and bone mineral content (BMC). A total of 127 patients (OCC (n = 69) and NOCC (n = 58)) were eligible. Body composition parameters were progressively lost during CCRT in both subgroups. Extremities lost more muscle mass than the trunk for LBM, whereas the trunk lost more fat mass than the extremities for TFM. BMC loss preferentially occurred in the trunk region. Different factors were independently correlated with the interval changes of each body composition parameter for both OCC and NOCC subgroups, particularly mean daily calorie intake for LBM and TFM loss, and total lymphocyte count for BMC loss. In conclusion, treatment-interval TBC changes and related contributing factors differ between the OCC and NOCC subgroups.

Highlights

Head and neck squamous cell carcinoma (HNSCC) arising from the upper aerodigestive tract is a heterogeneous disease with varied pathological and therapeutic attributes that may modify the clinical presentation and outcomes [1]
Patients with locally advanced head and neck squamous cell carcinoma (LAHNSCC) could receive concurrent chemoradiotherapy (CCRT) as either surgery followed by adjuvant therapy for patients with oral cavity cancer (OCC) or as primary therapy with curative intent for non-oral cavity cancer (NOCC, oropharynx, hypopharynx, nasopharynx, and larynx)
To further investigate the difference in total body composition (TBC) change throughout the CCRT course between the OCC and non-oral cavity with primary CCRT (NOCC) subgroups, we found that in accordance with the entire group, both subgroups showed similar and significant proportions of loss in Body mass index (BMI), body weight (BW), lean body mass (LBM), total fat mass (TFM), ASM, and bone mineral content (BMC); the TBC ratios were unchanged: for the OCC subgroup, the mean TBC was 69.1% LBM, 26.8% TFM, and 4.1% BMC at the start of CCRT, with 68.7%

Summary

Introduction

Head and neck squamous cell carcinoma (HNSCC) arising from the upper aerodigestive tract is a heterogeneous disease with varied pathological and therapeutic attributes that may modify the clinical presentation and outcomes [1]. Most patients with HNSCC present with locally advanced disease, many of whom need to be treated with concurrent chemoradiotherapy (CCRT). Patients with locally advanced head and neck squamous cell carcinoma (LAHNSCC) could receive CCRT as either surgery followed by adjuvant therapy for patients with oral cavity cancer (OCC) or as primary therapy with curative intent for non-oral cavity cancer (NOCC, oropharynx, hypopharynx, nasopharynx, and larynx). Owing to the tumor characteristics (location, size, and regional lymph node invasion), lifestyle habits, metabolic derangement, inflammatory factors induced by tumor and microenvironment, as well as significant in-field and systemic toxicity from CCRT, these patients often experience nutritional alterations and body weight loss before and during treatment [1,2,3,4,5]. Monitoring the TBC change may offer an accurate assessment of nutritional/inflammatory alterations during CCRT [8,9,10]

Methods

Results

Conclusion