Abstract
Background and AimsMalnutrition is a concern in patients with nasopharyngeal carcinoma (NPC) during chemoradiotherapy (CRT)/radiotherapy (RT), which is considered to be related with radiation–induced oral mucositis (ROM). The study aimed to evaluate the nutritional status of NPC patients during RT and investigate its association with ROM.MethodsA prospective study was conducted in NPC patients. Patients were divided into three subgroups (mild, moderate, and severe groups) based on the duration of severe ROM (≥ grade 3). Body weight, body mass index (BMI), albumin, prealbumin, NRS2002, and ROM grade were assessed on a weekly basis before and during CRT/RT. The statistical analysis was performed in the overall group and between three subgroups.ResultsA total of 176 patients were included. In the overall group, body weight and BMI kept decreasing since week 1 of RT, and NRS2002 score and ROM grade increased (p < 0.001). NRS2002 score and prealbumin levels were significantly different between each subgroup (p ≤ 0.046). Significant differences were observed in the proportion of patients receiving enteral nutrition, duration of parenteral nutrition, and total calories provided by nutritional support among three subgroups (p = 0.045–0.001).ConclusionsMalnutrition occurred early in NPC patients and worsened continuously during RT. ROM was strongly associated with nutritional status. Nutritional support should be provided at the start of RT, especially in patients at high-risk of severe ROM.
Highlights
Nasopharyngeal carcinoma (NPC), an epithelial cell cancer in the nasopharynx, is a rare malignancy [1, 2]
The inclusion criteria: 1) NPC patients with confirmed pathogenesis; 2) cancer stages I–IVB according to the 8th version of the American Joint Committee on Cancer; 3) patients between the ages of 18 and 75 years; 4) performance status of 0 or 1 based on the Eastern Cooperative Oncology Group; 5) no bone marrow, renal, hepatic disorders; 6) patients willing to participate in the study and sign an informed consent
Since NRS2002 score and prealbumin levels were significantly different between each subgroup with One Way ANOVA, we further used Repeated Measures ANOVA to verify it, which showed that the differences remained significant (p < 0.001, p = 0.041; Supplemental Tables 2, 3)
Summary
Nasopharyngeal carcinoma (NPC), an epithelial cell cancer in the nasopharynx, is a rare malignancy [1, 2]. The prognosis of NPC is good, certain acute side effects of RT may affect the course of treatment, including xerostomia, skin reactions, hearing loss, pharyngitis, vomiting, and radiation-induced oral mucositis (ROM) [5,6,7]. In severe ROM, patients experience ulceration, necrosis, severe oral pain, and malnutrition due to difficulties in food intake [10, 12, 13]. In mild ROM (≤ grade 2), 38% of patients still experience difficulties with food intake [8]. Malnutrition is a concern in patients with nasopharyngeal carcinoma (NPC) during chemoradiotherapy (CRT)/radiotherapy (RT), which is considered to be related with radiation–induced oral mucositis (ROM).
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