Abstract
Background: Severe weight loss commonly occurs before and during chemo-irradiation for Stage III and IV SCCHN. Nevertheless, the effects of severe weight loss on short and long term outcomes are unknown. Objective: To evaluate effects of pre-treatment weight loss versus weight loss during chemotherapy/radiation for advanced operable SCCHN on toxicity, tumor response, recurrent tumor and survival. Methods: Records of 52 patients with Stage III and IV, clinically operable SCCHN who underwent primary high-dose radiotherapy and concomitant chemotherapy (cisplatin, 20mg/M2/four consecutive days during weeks 1, 4, and 7 of radiotherapy) (CTRT) were examined retrospectively in two groups: <7.5% weight loss in three months during CTRT (NON-SEVERE; n=12) and >7.5% weight loss (SEVERE; n=41). Data included tumor site, grade, stage, pre-CTRT weight loss, CTRT toxicity, response (CCR = Clinical Complete; HCR = Histologic Complete without residual tumor), surgeries, recurrence, and overall and disease-free survival. Statistical analysis: Chi-square, ANOVA, and Kaplan-Meier. Results: Per study design, weight loss was greater in the SEVERE group versus NON-SEVERE (-17.3% +- 7.9% versus -2.9% +- 4.2%, p<0.0001). Pre-CTRT weight loss, age, stage, grade, toxicity of CTRT and post-CTRT surgery did not vary significantly. SEVERE tongue/hypopharynx primary site was increased (66% versus 18%, p<0.05). CCR and HCR were achieved in 5/11 (45%) of NON-SEVERE and 29/41 (71%) SEVERE. SCCHN recurred in 1/11 (9%) NON-SEVERE and 12/41 (29%) SEVERE patients. Kaplan-Meier Overall 60 month survival was 56% SEVERE and 14% NON-SEVERE (p<0.001). Disease-Free survival was 65% SEVERE and 22% NON-SEVERE (p<0.001). Conclusions: In spite of greater tongue/hypopharynx primaries and independent of pre-treatment weight loss, SEVERE Stage III/IV SCCHN CTRT toxicity, post-CTRT operations, and tumor recurrence did not increase. SEVERE CCR/HCR was excellent and SEVERE overall and disease-free survivals exceeded NON-SEVERE significantly. The pathophysiological mechanisms underlying these new and clinically important findings are not clear from the data.
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