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Jpn J Clin Oncol. 2019 Oct 28. pii: hyz121. doi: 10.1093/jjco/hyz121. [Epub ahead of print]

Nutritional support dependence after curative chemoradiotherapy in head and neck cancer: supplementary analysis of a phase II trial (JCOG0706S1).

Author information

1
Department of Medical Oncology and Hematology, Kobe University Hospital, Kobe, Japan.
2
Kobe University Hospital Cancer Center, Kobe, Japan.
3
Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan.
4
Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan.
5
Department of Otolaryngology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
6
Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan.
7
Department of Head and Neck Surgery, Hyogo Cancer Center, Akashi, Japan.
8
Department of Head and Neck Surgery, Shikoku Cancer Center, Matsuyama, Japan.
9
Division of Head and Neck Surgery, Miyagi Cancer Center, Natori, Japan.
10
Division of Clinical Oncology, Shizuoka Cancer Center, Shizuoka, Japan.
11
Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa.
12
Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan.

Abstract

OBJECTIVES:

To explore the risk factors of laryngo-esophageal dysfunction-free survival and nutritional support dependence over 12 months in patients with unresectable locally advanced head and neck carcinomas who received chemoradiotherapy in a phase II trial of JCOG0706 (UMIN000001272).

METHODS:

Forty-five patients received radiation therapy for a total of 70 Gy/35fr concurrently with S-1 and cisplatin. Risk factors of laryngo-esophageal dysfunction-free survival and nutritional support dependence over 12 months were analyzed using Cox regression models and logistic regression models, respectively, with consideration to patient laboratory data just before chemoradiotherapy. Radiation fields were reviewed to analyze the relationship between the extent of the irradiated field and functional outcome.

RESULTS:

With a median follow-up period of 3.5 years, 3-year laryngo-esophageal dysfunction-free survival was 48.9%. For laryngo-esophageal dysfunction-free survival, hazards ratio of 2.35 in patients with nutritional support at registration (vs. without nutritional support; 95% confidence interval 0.96-5.76). For nutritional support dependence over 12 months, odds ratio was 6.77 in patients with hemoglobin less than the median of 13.4 g/dl (vs. higher than or equal to the median; 95% confidence interval 1.24-36.85) and was 6.00 in patients with albumin less than the median of 3.9 g/dl (vs. higher than or equal to the median; 95% confidence interval 1.11-32.54). Primary sites in disease-free patients with nutritional support dependence over 12 months were the oropharynx (N = 2) or hypopharynx (N = 1), and all pharyngeal constrictor muscles were included in irradiated fields with a curative dose.

CONCLUSIONS:

This supplementary analysis showed that pretreatment severe dysphagia requiring nutritional support, anemia and hypoalbuminemia might have a negative prognostic impact on long-term functional outcomes after curative chemoradiotherapy in head and neck cancer.

KEYWORDS:

chemoradiotherapy; head and neck carcinoma; laryngo-esophageal dysfunction-free survival; nutritional support dependence; risk factor

PMID:
31665358
DOI:
10.1093/jjco/hyz121

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