Study On Relationship Between Nutritional Status And Acute Toxicity Reaction In The Head And Neck Cancer Patients While Receiving Radiotherapy

Objectives To investigate the nutritional status of patients with head and neck cancer before and during radiotherapy and its influencing factors, and explore the relationship between nutritional status and acute radiotoxicity. MethodsFrom November, 2008 to November, 2009, 130 head and neck cancer patients who were received the radiotherapy were surveyed by trained interviewers with self-constructed questionnaires. The questionnaires consisted of demographic data (age, gender, inhabited area, marital status, vocation, educational background, average monthly income, health care cost, smoking , drinking, appetite change, body weight change prior to hospitalization), clinical informations (operation history, chemotherapy history, radiotherapy history, lesion location, clinical stage, T stage, N stage, concomitant disease, radiation modality, radiation dose, radiation frequency),nutritional status (body height, body weight, arm circumference, triceps skinfold thickness, arm muscle circumference, body mass index and hematology index--leucocyte, lymphocyte, lymphocyte percentage, akaryocyte, haematoglobin, serum prealbumin, transferrin ),and Acute radiotoxicities (fatigue, apocleisis, radiodermatitis, oral mucositis, Xerostomia, dysphagia, dysgeusia, nausea and vomiting, pharyngitis/ laryngitis). We measured the indices of nutritional status and assessed radiotoxicities before radiation, 2 weeks and 4 weeks after beginning of radiation, and the end of radiation respectively. Acute radiotoxicities were evaluated according to Common Toxicity Criteria (version 3.0). A comprehensive model was built to assess the nutritional status by factor analysis. Influencing factors of nutritional status were analyzed by generalized estimating equation. Relationships between nutritional status and acute radiotoxicities were analyzed by generalized additive models. Results 1. According to comprehensive evaluation index, malnourished cases were 88(67.7%) Before radiotherapy. There were significant differences of malnourished rates between the men and the women, the younger and the elder respectively(χ~2=10.15, P =0.017 andχ~2=17.14, P =0.009). The malnourished rate of the men was lower than that of the women and the younger was lower than the elder respectively. The malnourished rate was increasing during radiotherapy and the difference among each time was significant(χ~2=20.73, P =0.014). 2. Acute radiotoxicity: The incidences of apocleisis, dysphagia, xerostomia, oral mucositis, fatigue, pharyngitis/laryngitis and dysgeusia were 100%, 99.8%, 99.2%, 93.2%, 92.4%, 90.0% and 59.2% respectively. The more irradiation dose was accepted, the higher grade of radiotoxicity occurred during radiotherapy. 3. The influencing factors of the nutritional status were age, inhabited area, body weight change prior to hospitalization, lesion location, T stage, operation history, chemotherapy history, radiotherapy history, radiation modality, radiation frequency. 4. we found a linear relationship between nutritional status and radiodermatitis, Xerostomia, fatigue, apocleisis, pharyngitis/laryngitis. Their parameter estimation values were -0.81898, -0.68353, -0.46221 and -0.33023, -0.31678, and their P values were 0.0001, 0.0001, 0.0001, 0.0018 and 0.0077 respectively. It showed that patients with good nutritional status would have mild acute radiotoxicities. Simultaneously , we found a non-linear relationship, maybe some curve relationship between nutritional status and nausea and vomiting and oral mucositis(χ~2=16.7992, P =0.001;χ~2= 3.6530,P =0.0370). The malnourished rate was significant difference among each radiation periods(parameter estimation value=0.50747,P=0.0001). It showed that the malnourished rate was increasing with the increase of irradiation dose. Conclusion①There are some relationships between nutritional status and radiotoxicities.②During radiotherapy, the nutritional status of Head and neck cancer patients is deteriorating while the cases with radiotoxicity is growing.③Our suggestion is that all malnutrition patients, especially female patients or elder patients, should be given nutritional support earlier before radiotherapy to improve the patient's nutritional status and reduce the incidence of radiotoxicity.