Pretreatment nutritional risk as a prognostic factor in head and neck cancer patients receiving radiotherapy or chemoradiotherapy.

Abstract

Head and neck cancer patients often experience nutritional deterioration, which decreases their treatment tolerance and is associated with poor outcomes. We analyzed nutritional status in head and neck cancer patients before and during treatment, and its impact on clinical outcomes. Between January 2009 and April 2012, 336 head and neck cancer patients receiving radiotherapy or chemoradiotherapy were prospectively entered into the study. The Nutritional Risk Screening 2002 (NRS 2002) assessment was used to evaluate their nutritional status. A total of 227 patients with nasopharyngeal carcinoma and 109 patients with head and neck cancers were analyzed. The proportion of patients receiving radiotherapy or chemoradiotherapy at nutritional risk was 61.3%, with 11.9% at risk before treatment and 49.4% developing risk during treatment. In multivariate analysis, nutritional risk before treatment was associated with T stage for the two groups. Risk was significantly higher in patients receiving concurrent chemoradiotherapy during treatment for nasopharygeal carcinoma patients. The prognosis of pretreatment nutritional risk patients was worse than those becoming at risk during treatment and those without nutritional risk (3-year overall survival 62.9% vs 81.7% vs 80.6%, p=0.026; 3-year disease-free survival 64.8% vs 84.5% vs 84.4%, p=0.019). The incidence of nutritional risk is high in head and neck cancer patients receiving radiotherapy or chemoradiotherapy, especially during treatment. Pretreatment nutritional risk evaluated using the NRS 2002 can predict patient prognosis.