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Clinical Nutrition

New radiotherapy techniques do not reduce the need for nutrition intervention in patients with head and neck cancer

European Journal of Clinical Nutrition volume 69, pages 1119–1124 (2015)Cite this article

Subjects

Abstract

Background/Objectives:

Since 2007, our institution has used validated guidelines for the insertion of proactive gastrostomy feeding tubes in patients with head and neck cancer. Helical intensity-modulated radiotherapy (H-IMRT) delivered by Tomotherapy, is an advanced radiotherapy technique introduced at our centre in 2010. This form of therapy reduces long-term treatment-related toxicity to normal tissues. The aim of this study is to compare weight change and need for tube feeding following H-IMRT (n=53) with patients that would have previously been treated with three-dimensional conformal radiotherapy (n=134).

Subjects/Methods:

Patients with head and neck cancer assessed as high nutritional risk with recommendation for proactive gastrostomy were identified from cohorts from 2007 to 2008 and 2010 to 2011. Retrospective data were collected on clinical factors, weight change from baseline to completion of treatment, incidence of severe weight loss (⩾10%) and tube feeding. Statistical analyses to compare outcomes between the two treatments included χ2-test, Fisher’s exact and two-sample Wilcoxon tests (P<0.05).

Results:

The H-IMRT cohort had higher proportions of patients with definitive chemoradiotherapy (P=0.032) and more advanced N stage (P<0.001). Nutrition outcomes were not significantly different between H-IMRT and conformal radiotherapy, respectively: need for proactive gastrostomy (n=49, 92% versus n=115, 86%, P=0.213), median percentage weight change (−7.2% versus −7.3%, P=0.573) and severe weight loss incidence (28% versus 27%, P=0.843).

Conclusions:

Both groups had median weight loss >5% and high incidences of tube feeding and severe weight loss. Nutrition intervention remains critical in this patient population, despite advances in radiotherapy techniques, and no changes to current management are recommended.

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Acknowledgements

We thank Dr Tuan Ha and Vanessa Getliffe for their assistance in data collection, and the staff in medical records and the Combined Head and Neck Clinic at the Royal Brisbane and Women’s Hospital (RBWH) for their support. This study was supported by the Royal Brisbane and Women’s Hospital PhD Scholarship.

Author contributions

TB initiated the study concept. TB, JB, MB and BH contributed to study design. TB and CL participated in the acquisition of data. TB analysed the data and prepared the first draft of the manuscript. All the authors participated in the interpretation of the data, critical revision of the manuscript and the final approval of the submitted version. As corresponding author, TB has full access to all the data in the study and has final responsibility for the decision to submit for publication.

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Authors and Affiliations

  1. Centre for Dietetics Research (C-DIET-R), School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia

    T Brown & J D Bauer

  2. Department of Nutrition and Dietetics, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia

    T Brown & M Banks

  3. Cancer Care Services, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia

    B G M Hughes, C Lin & L M Kenny

  4. School of Medicine, University of Queensland, St Lucia, Queensland, Australia

    B G M Hughes

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Correspondence to T Brown.

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Competing interests

TB received a Royal Brisbane and Women’s Hospital PhD Scholarship. The funding body were not involved in the study design, data collection, analysis and interpretation of results, writing of the report or the decision to submit the article for publication. All other authors have no conflicts of interest to declare.

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Brown, T., Banks, M., Hughes, B. et al. New radiotherapy techniques do not reduce the need for nutrition intervention in patients with head and neck cancer. Eur J Clin Nutr 69, 1119–1124 (2015). https://doi.org/10.1038/ejcn.2015.141

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  • DOI: https://doi.org/10.1038/ejcn.2015.141

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