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Metabolic consequences of weight (WT) loss during concurrent chemoirradiation of head and neck (HN) cancer
S498
I. J. Radiation Oncology
2270
● Biology ● Physics
Volume 60, Number 1, Supplement, 2004
Metabolic Consequences of Weight (Wt) Loss During Concurrent Chemoirradiation of Head and Neck (HN) Cancer
A. Lin,1 S. Jabbari,1 F. P. Worden,2 J. J. Liao,3 G. G. Nyquist,4 M. J. Schipper,5 C. R. Bradford,6 T. N. Teknos,6 D. B. Chepeha,6 S. Urba,2 G. T. Wolf,6 A. Eisbruch1 1 Radiation Oncology, University of Michigan, Ann Arbor, MI, 2Medicine, University of Michigan, Ann Arbor, MI, 3 Radiation Oncology, Georgetown University, Washington, DC, 4Surgery, University of California San Francisco-Eastbay, San Francisco, CA, 5Biostatistics, University of Michigan, Ann Arbor, MI, 6Otolaryngology, University of Michigan, Ann Arbor, MI Purpose/Objective: Concurrent chemoirradiation of HN cancer often leads to significant wt loss due to acute mucositis and dysphagia. The metabolic consequences of wt loss during chemoirradiation have not been reported previously, and are the subject of this study. Materials/Methods: 96 patients with locally advanced head and neck cancer were treated at the University of Michigan from 1995 to 2001 with induction cisplatin/5-fluorouracil followed with XRT (70 Gy over 7 weeks) concurrent with cisplatin (100 mg/m2 every 3 weeks). Primary sites included larynx (48 pts), hypopharynx (3 pts), oropharynx (40 pts), and oral cavity (5 pts). Stages were III (38 pts), and IV (58 pts). Baseline body weight, creatinine clearance, and basic metabolic laboratory evaluation were obtained prior to initiation of chemotherapy and prior to radiation. During the course of radiotherapy, weekly weights and laboratory evaluation were measured. Greatest percent weight change and changes in laboratory values during RT were calculated relative to the pre-chemo and pre-RT values. Results: 34/96 (35%) patients had greater than 10% body weight loss, and 6 of these patients (18%) had an increase in creatinine ⬎100% (maximum creatinine value of 3.2). None of the 62 patients with weight loss ⬍10% had a ⬎100% increase in creatinine. There was a significant correlation between percent body weight loss and percent creatinine rise during the course of chemoradiotherapy (p ⬍ 0.0001). A significant correlation between percent body weight loss and percent BUN increase also existed (p ⫽ 0.0221). Clinical factors such as age, gender, tobacco history, hypertension, and diabetes mellitus were not significant predictors of renal dysfunction. Changes in sodium, potassium, chloride, CO2, albumin, uric acid, and magnesium during chemoirradiation were not significant, nor were any of these changes correlated with weight loss. Feeding tubes (PEG) were placed in 36/96 (37.5%) patients. Prophylactic tubes were placed in 14 pts, of whom 4 (29%) had wt loss ⬎10%, compared with 21/60 (35%) pts without PEG who had wt loss ⬎10% (p ⫽ 0.65). In addition, 20 pts had PEGs placed following wt loss (median wt loss of 6.9 lbs), of whom 75% retained their weight following PEG placement. Conclusions: Significant wt loss (⬎10% body weight) experienced with concurrent cisplatin-RT was found to be associated with cisplatin-related nephrotoxicity. No other metabolic abnormalities were found to be significantly correlated with wt loss in this study. These findings emphasize the importance of aggressive supportive measures of hydration and nutrition to prevent undue toxicity from therapy. To our knowledge, it is to date the only study examining these aspects of treatment.
2271
Long-Term Survival and Functional Quality of Life Assessments in Patients with Locally Advanced Unresectable Squamous Cell Carcinomas of the Head and Neck Treated with Concurrent Chemoradiation
P. H. Sullivan,1 R. Taylor,2 R. Ord,4 J. Wolf,2 W. Gray,2 D. VanEcho,3 Y. Kwok,1 M. Suntharalingam1 Radiation Oncology, University of Maryland, Baltimore, MD, 2Otolaryngology, University of Maryland, Baltimore, MD, 3 Medical Oncology, University of Maryland, Baltimore, MD, 4Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD 1
Purpose/Objective: Concurrent chemotherapy and radiation has been shown to be effective treatment for unresectable squamous cell carcinomas of the head and neck (SCCHN). While initial data has been encouraging, few studies have reported 5-year survival in conjunction with patient-assessed functional quality of life (QOL) outcomes. This report details the long-term survival and laryngeal/pharyngeal functional outcome of a phase II trial evaluating the combination of weekly carboplatin (CBDCA), paclitaxel, and daily radiation for patients with locally advanced unresectable disease. Materials/Methods: From 1993–1998, 62 patients with Stage III-IV SCCHN were prospectively treated with RT to 70.2 Gy at 1.8 Gy/fraction/day with weekly chemotherapy consisting of paclitaxel (45 mg/m(2)/wk) and carboplatin (100 mg/m(2)/wk). All patients presented with locally advanced disease (93% Stage IV); 77% had T4 disease and 21% had T3 disease. Fifty-eight percent had N2b-N3 disease. Sixty patients were evaluated for response and survival with a mean follow-up of 52 months (range 2–119). In March 2004, long-term functional and symptom-related quality of life analysis was performed in surviving patients using the Quality of Life-Radiation Therapy Instrument Head & Neck Module (QOL-RTI/H&N). This questionnaire assesses pain, appearance, speech, chewing and swallowing, mucous and saliva, taste, and cough on a 0 –10 Likert type scale, with a QOL score (QS) of 10 representing the highest perceived toxicity. Results: Ninety-eight percent of patients completed the prescribed therapy. A clinical complete response (CR) at the primary site was obtained in 82%, with a total (primary site and neck) CR rate of 75%. Local-control for the entire cohort at 1 year,
I. J. Radiation Oncology
2270
● Biology ● Physics
Volume 60, Number 1, Supplement, 2004
Metabolic Consequences of Weight (Wt) Loss During Concurrent Chemoirradiation of Head and Neck (HN) Cancer
A. Lin,1 S. Jabbari,1 F. P. Worden,2 J. J. Liao,3 G. G. Nyquist,4 M. J. Schipper,5 C. R. Bradford,6 T. N. Teknos,6 D. B. Chepeha,6 S. Urba,2 G. T. Wolf,6 A. Eisbruch1 1 Radiation Oncology, University of Michigan, Ann Arbor, MI, 2Medicine, University of Michigan, Ann Arbor, MI, 3 Radiation Oncology, Georgetown University, Washington, DC, 4Surgery, University of California San Francisco-Eastbay, San Francisco, CA, 5Biostatistics, University of Michigan, Ann Arbor, MI, 6Otolaryngology, University of Michigan, Ann Arbor, MI Purpose/Objective: Concurrent chemoirradiation of HN cancer often leads to significant wt loss due to acute mucositis and dysphagia. The metabolic consequences of wt loss during chemoirradiation have not been reported previously, and are the subject of this study. Materials/Methods: 96 patients with locally advanced head and neck cancer were treated at the University of Michigan from 1995 to 2001 with induction cisplatin/5-fluorouracil followed with XRT (70 Gy over 7 weeks) concurrent with cisplatin (100 mg/m2 every 3 weeks). Primary sites included larynx (48 pts), hypopharynx (3 pts), oropharynx (40 pts), and oral cavity (5 pts). Stages were III (38 pts), and IV (58 pts). Baseline body weight, creatinine clearance, and basic metabolic laboratory evaluation were obtained prior to initiation of chemotherapy and prior to radiation. During the course of radiotherapy, weekly weights and laboratory evaluation were measured. Greatest percent weight change and changes in laboratory values during RT were calculated relative to the pre-chemo and pre-RT values. Results: 34/96 (35%) patients had greater than 10% body weight loss, and 6 of these patients (18%) had an increase in creatinine ⬎100% (maximum creatinine value of 3.2). None of the 62 patients with weight loss ⬍10% had a ⬎100% increase in creatinine. There was a significant correlation between percent body weight loss and percent creatinine rise during the course of chemoradiotherapy (p ⬍ 0.0001). A significant correlation between percent body weight loss and percent BUN increase also existed (p ⫽ 0.0221). Clinical factors such as age, gender, tobacco history, hypertension, and diabetes mellitus were not significant predictors of renal dysfunction. Changes in sodium, potassium, chloride, CO2, albumin, uric acid, and magnesium during chemoirradiation were not significant, nor were any of these changes correlated with weight loss. Feeding tubes (PEG) were placed in 36/96 (37.5%) patients. Prophylactic tubes were placed in 14 pts, of whom 4 (29%) had wt loss ⬎10%, compared with 21/60 (35%) pts without PEG who had wt loss ⬎10% (p ⫽ 0.65). In addition, 20 pts had PEGs placed following wt loss (median wt loss of 6.9 lbs), of whom 75% retained their weight following PEG placement. Conclusions: Significant wt loss (⬎10% body weight) experienced with concurrent cisplatin-RT was found to be associated with cisplatin-related nephrotoxicity. No other metabolic abnormalities were found to be significantly correlated with wt loss in this study. These findings emphasize the importance of aggressive supportive measures of hydration and nutrition to prevent undue toxicity from therapy. To our knowledge, it is to date the only study examining these aspects of treatment.
2271
Long-Term Survival and Functional Quality of Life Assessments in Patients with Locally Advanced Unresectable Squamous Cell Carcinomas of the Head and Neck Treated with Concurrent Chemoradiation
P. H. Sullivan,1 R. Taylor,2 R. Ord,4 J. Wolf,2 W. Gray,2 D. VanEcho,3 Y. Kwok,1 M. Suntharalingam1 Radiation Oncology, University of Maryland, Baltimore, MD, 2Otolaryngology, University of Maryland, Baltimore, MD, 3 Medical Oncology, University of Maryland, Baltimore, MD, 4Oral and Maxillofacial Surgery, University of Maryland, Baltimore, MD 1
Purpose/Objective: Concurrent chemotherapy and radiation has been shown to be effective treatment for unresectable squamous cell carcinomas of the head and neck (SCCHN). While initial data has been encouraging, few studies have reported 5-year survival in conjunction with patient-assessed functional quality of life (QOL) outcomes. This report details the long-term survival and laryngeal/pharyngeal functional outcome of a phase II trial evaluating the combination of weekly carboplatin (CBDCA), paclitaxel, and daily radiation for patients with locally advanced unresectable disease. Materials/Methods: From 1993–1998, 62 patients with Stage III-IV SCCHN were prospectively treated with RT to 70.2 Gy at 1.8 Gy/fraction/day with weekly chemotherapy consisting of paclitaxel (45 mg/m(2)/wk) and carboplatin (100 mg/m(2)/wk). All patients presented with locally advanced disease (93% Stage IV); 77% had T4 disease and 21% had T3 disease. Fifty-eight percent had N2b-N3 disease. Sixty patients were evaluated for response and survival with a mean follow-up of 52 months (range 2–119). In March 2004, long-term functional and symptom-related quality of life analysis was performed in surviving patients using the Quality of Life-Radiation Therapy Instrument Head & Neck Module (QOL-RTI/H&N). This questionnaire assesses pain, appearance, speech, chewing and swallowing, mucous and saliva, taste, and cough on a 0 –10 Likert type scale, with a QOL score (QS) of 10 representing the highest perceived toxicity. Results: Ninety-eight percent of patients completed the prescribed therapy. A clinical complete response (CR) at the primary site was obtained in 82%, with a total (primary site and neck) CR rate of 75%. Local-control for the entire cohort at 1 year,