Objective: To evaluate the impact of systematic nutrition management (SNM) on nutritional status, treatment-related toxicity, quality of life (QoL), response rates, and survival in patients with locally advanced nasopharyngeal carcinoma (LA-NPC) treated by radiotherapy (RT).
Methods: In this retrospective study, 56 patients with LA-NPC were selected as nutrition management group (NG) for SNM during RT till 1 month later. Another 56 patients with LA-NPC receiving RT without SNM as control group (CG) were identified from the hospital database and matched pairs with NG patients according to age, gender, stage, and body mass index (BMI) prior to RT.
Results: At 1 month after RT, the percentage of malnourished patients with BMI <18.5 kg/m2 was statistically significant reduced in NG as compared to the CG group (35.7% vs 58.9%, P=0.014). Nutritional indexes of body weight, hemoglobin, prealbumin, and lymphocyte in the NG were statistically significant higher than those in the CG group (P<0.05). NG patients had statistically significant less grade 3–4 oral mucositis during RT compared with the CG group (32.1% vs 51.8%, P=0.035). Furthermore, at 1 month after RT, an improved QoL was observed in NG patients with respect to physical, role and social functions, symptom scales of fatigue and pain, and the global health status as compared to the CG group (P<0.05). With a median follow-up of 24.8 months, there were no statistical differences between NG and CG (P>0.05) for the 2-year progression-free survival and overall survival (84.2% versus 79.5% and 94.7% versus 92.3%, respectively.).
Conclusion: SNM for LA-NPC patients treated by RT resulted in better nutritional status, reduced treatment-related toxicity and improved QoL.
Keywords: nasopharyngeal carcinoma, radiotherapy, nutrition management, clinical outcome
Nasopharyngeal carcinoma (NPC) is one of the most prevalent malignancies in the Southeast Asia populations, and most patients are diagnosed with locally advanced disease (LA-NPC).1 With intensity-modulated radiotherapy (IMRT) and systemic treatment, disease control and survival of LA-NPC patients have been substantially improved.2–4 Nevertheless, nutritional problems such as weight loss and reduced protein-calorie intake remain quite common during RT, which have been found to be associated with lower survival rate and worse quality of life (QoL).5–9 Systematic nutritional monitoring and intervention for patients with head and neck cancer could improve treatment outcomes.10–12 So far, however, there is little research focusing on nutrition management for LA-NPC patients, which differ greatly from non-NPC head and neck cancer patients in terms of epidemiology, etiology, pathology, clinical presentation, treatment method, and response to treatment.
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