Head and neck cancer patients under (chemo-)radiotherapy undergoing nutritional intervention: Results from the prospective randomized HEADNUT-trial
•Nutritional status impacts outcome of patients with head and neck cancer after (chemo-)radiotherapy.•Parameters from bioelectric impedance analysis may serve as indicators for overall survival.•So-called phase angle and fat-free mass index from bioelectric impedance analysis may predict overall sur...
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| Veröffentlicht in: | Radiotherapy and oncology 2021-06, Vol.159, p.82-90 |
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| creator | Löser, Anastassia Abel, Jakob Kutz, Laura Magdalena Krause, Linda Finger, Anna Greinert, Franziska Sommer, Margaret Lorenz, Tessa Culmann, Eva von Grundherr, Julia Wegert, Luisa Lehmann, Loreen Matnjani, Gesa Schwarz, Rudolf Brackrock, Sophie Krüll, Andreas Petersen, Cordula Carl, Cedric Oliver |
| description | •Nutritional status impacts outcome of patients with head and neck cancer after (chemo-)radiotherapy.•Parameters from bioelectric impedance analysis may serve as indicators for overall survival.•So-called phase angle and fat-free mass index from bioelectric impedance analysis may predict overall survival in head and neck cancer patients after (chemo-)radiotherapy.•Albumin at the end of (chemo-)radiotherapy predicts overall survival in head and neck cancer patients after (chemo-)radiotherapy.
Patients with squamous cell carcinoma of the head and neck undergoing (chemo-)radiotherapy are at high risk of malnutrition. Nevertheless, there is still a lack of prospective, randomized trials investigating the influence of nutritional status on therapy-related toxicity and patients’ outcome.
Between October 2018 and October 2020, 61 patients were randomized into an intervention and control group. Questionnaires (MUST, NRS-2002, and Nutriscore), clinical examinations, laboratory analyses, and bioelectrical impedance analysis (BIA) were used to assess nutritional status for all patients at the beginning and end of therapy as well as every 2 weeks during therapy. The intervention consisted of an individualized nutritional counseling every 2 weeks during therapy.
Median baseline BMI for all participants was 23.8 (14.5–37.2) kg/m2 and dropped to 22.9 (16.8–33) kg/m2 after therapy (p |
| doi_str_mv | 10.1016/j.radonc.2021.03.019 |
| format | Article |
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Patients with squamous cell carcinoma of the head and neck undergoing (chemo-)radiotherapy are at high risk of malnutrition. Nevertheless, there is still a lack of prospective, randomized trials investigating the influence of nutritional status on therapy-related toxicity and patients’ outcome.
Between October 2018 and October 2020, 61 patients were randomized into an intervention and control group. Questionnaires (MUST, NRS-2002, and Nutriscore), clinical examinations, laboratory analyses, and bioelectrical impedance analysis (BIA) were used to assess nutritional status for all patients at the beginning and end of therapy as well as every 2 weeks during therapy. The intervention consisted of an individualized nutritional counseling every 2 weeks during therapy.
Median baseline BMI for all participants was 23.8 (14.5–37.2) kg/m2 and dropped to 22.9 (16.8–33) kg/m2 after therapy (p < 0.001). In all patients, median baseline fat-free mass index (FFMI) was 18.1 (14–24.7) kg/m2 and decreased to 17.8 (13.4–21.6) kg/m2 till the end of therapy (p < 0.001). Compliant patients with a BMI < 22 kg/m2 presented with less weight loss in the intervention group compared to the control (p = 0.015, CI: 0.33–2.95). At baseline, MUST was the only screening-test which showed both good sensitivity (86%) and specificity (88%) in detecting malnutrition. Median follow-up was 15 (1–26) months and is still ongoing. 2-year overall survival rate was 70% in the control and 79% in the intervention group (log-rank p = 0.79). Pretherapeutic phase angle, posttherapeutic FFMI and albumin level were prognostic indicators for overall survival (log-rank p = 0.002, p = 0.008 and p = 0.016).
Malnutrition negatively impacts patients’ outcome under (chemo-)radiotherapy. Baseline phase angle, posttherapeutic FFMI and albumin level are proposed as reliable indicators for overall survival.
This study was registered within the German Clinical Trials Register (DRKS00016862).</description><identifier>ISSN: 0167-8140</identifier><identifier>EISSN: 1879-0887</identifier><identifier>DOI: 10.1016/j.radonc.2021.03.019</identifier><identifier>PMID: 33766702</identifier><language>eng</language><publisher>Ireland: Elsevier B.V</publisher><subject>Bioelectric impedance analysis ; Head and neck cancer ; Malnutrition ; Survival ; Toxicity</subject><ispartof>Radiotherapy and oncology, 2021-06, Vol.159, p.82-90</ispartof><rights>2021 Elsevier B.V.</rights><rights>Copyright © 2021 Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c428t-21ff84e67e327ff4537c2a57a51e8d3d91eb446f6153817a89c6daf5c87a428c3</citedby><cites>FETCH-LOGICAL-c428t-21ff84e67e327ff4537c2a57a51e8d3d91eb446f6153817a89c6daf5c87a428c3</cites><orcidid>0000-0002-8324-5884 ; 0000-0003-4981-7217 ; 0000-0003-0466-4712 ; 0000-0002-8490-5717</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.radonc.2021.03.019$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33766702$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Löser, Anastassia</creatorcontrib><creatorcontrib>Abel, Jakob</creatorcontrib><creatorcontrib>Kutz, Laura Magdalena</creatorcontrib><creatorcontrib>Krause, Linda</creatorcontrib><creatorcontrib>Finger, Anna</creatorcontrib><creatorcontrib>Greinert, Franziska</creatorcontrib><creatorcontrib>Sommer, Margaret</creatorcontrib><creatorcontrib>Lorenz, Tessa</creatorcontrib><creatorcontrib>Culmann, Eva</creatorcontrib><creatorcontrib>von Grundherr, Julia</creatorcontrib><creatorcontrib>Wegert, Luisa</creatorcontrib><creatorcontrib>Lehmann, Loreen</creatorcontrib><creatorcontrib>Matnjani, Gesa</creatorcontrib><creatorcontrib>Schwarz, Rudolf</creatorcontrib><creatorcontrib>Brackrock, Sophie</creatorcontrib><creatorcontrib>Krüll, Andreas</creatorcontrib><creatorcontrib>Petersen, Cordula</creatorcontrib><creatorcontrib>Carl, Cedric Oliver</creatorcontrib><title>Head and neck cancer patients under (chemo-)radiotherapy undergoing nutritional intervention: Results from the prospective randomized HEADNUT-trial</title><title>Radiotherapy and oncology</title><addtitle>Radiother Oncol</addtitle><description>•Nutritional status impacts outcome of patients with head and neck cancer after (chemo-)radiotherapy.•Parameters from bioelectric impedance analysis may serve as indicators for overall survival.•So-called phase angle and fat-free mass index from bioelectric impedance analysis may predict overall survival in head and neck cancer patients after (chemo-)radiotherapy.•Albumin at the end of (chemo-)radiotherapy predicts overall survival in head and neck cancer patients after (chemo-)radiotherapy.
Patients with squamous cell carcinoma of the head and neck undergoing (chemo-)radiotherapy are at high risk of malnutrition. Nevertheless, there is still a lack of prospective, randomized trials investigating the influence of nutritional status on therapy-related toxicity and patients’ outcome.
Between October 2018 and October 2020, 61 patients were randomized into an intervention and control group. Questionnaires (MUST, NRS-2002, and Nutriscore), clinical examinations, laboratory analyses, and bioelectrical impedance analysis (BIA) were used to assess nutritional status for all patients at the beginning and end of therapy as well as every 2 weeks during therapy. The intervention consisted of an individualized nutritional counseling every 2 weeks during therapy.
Median baseline BMI for all participants was 23.8 (14.5–37.2) kg/m2 and dropped to 22.9 (16.8–33) kg/m2 after therapy (p < 0.001). In all patients, median baseline fat-free mass index (FFMI) was 18.1 (14–24.7) kg/m2 and decreased to 17.8 (13.4–21.6) kg/m2 till the end of therapy (p < 0.001). Compliant patients with a BMI < 22 kg/m2 presented with less weight loss in the intervention group compared to the control (p = 0.015, CI: 0.33–2.95). At baseline, MUST was the only screening-test which showed both good sensitivity (86%) and specificity (88%) in detecting malnutrition. Median follow-up was 15 (1–26) months and is still ongoing. 2-year overall survival rate was 70% in the control and 79% in the intervention group (log-rank p = 0.79). Pretherapeutic phase angle, posttherapeutic FFMI and albumin level were prognostic indicators for overall survival (log-rank p = 0.002, p = 0.008 and p = 0.016).
Malnutrition negatively impacts patients’ outcome under (chemo-)radiotherapy. Baseline phase angle, posttherapeutic FFMI and albumin level are proposed as reliable indicators for overall survival.
This study was registered within the German Clinical Trials Register (DRKS00016862).</description><subject>Bioelectric impedance analysis</subject><subject>Head and neck cancer</subject><subject>Malnutrition</subject><subject>Survival</subject><subject>Toxicity</subject><issn>0167-8140</issn><issn>1879-0887</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9Uctu1DAUtRCITgt_gJCXZZHgRxJ7WCBVpWWQKpBQu7Zc-6b1kNjBTkYqv8EPc6sUlqysK5_HvecQ8oazmjPevd_X2foUXS2Y4DWTNePbZ2TDtdpWTGv1nGwQpirNG3ZEjkvZM8YEk-olOZJSdZ1iYkN-78B6aqOnEdwP6mx0kOlk5wBxLnSJHsdTdw9jqt6hYUjzPWQ7PaxfdynEOxqXOYc5pGgHGuIM-YBkHD_Q71CWAXX6nEaKTDrlVCZwczgAzWibxvALPN1dnH36enNdoY4dXpEXvR0KvH56T8jN5cX1-a66-vb5y_nZVeUaoedK8L7XDXQKpFB937RSOWFbZVsO2ku_5XDbNF3f8VZqrqzeus7bvnVaWRRw8oScrrq41M8FymzGUBwMg42QlmJEyzqhW4wMoc0Kdbh_ydCbKYfR5gfDmXmsw-zNWod5rMMwabAOpL19clhuR_D_SH_zR8DHFQB45yFANsVh8g58yJiS8Sn83-EPJlygYA</recordid><startdate>20210601</startdate><enddate>20210601</enddate><creator>Löser, Anastassia</creator><creator>Abel, Jakob</creator><creator>Kutz, Laura Magdalena</creator><creator>Krause, Linda</creator><creator>Finger, Anna</creator><creator>Greinert, Franziska</creator><creator>Sommer, Margaret</creator><creator>Lorenz, Tessa</creator><creator>Culmann, Eva</creator><creator>von Grundherr, Julia</creator><creator>Wegert, Luisa</creator><creator>Lehmann, Loreen</creator><creator>Matnjani, Gesa</creator><creator>Schwarz, Rudolf</creator><creator>Brackrock, Sophie</creator><creator>Krüll, Andreas</creator><creator>Petersen, Cordula</creator><creator>Carl, Cedric Oliver</creator><general>Elsevier B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8324-5884</orcidid><orcidid>https://orcid.org/0000-0003-4981-7217</orcidid><orcidid>https://orcid.org/0000-0003-0466-4712</orcidid><orcidid>https://orcid.org/0000-0002-8490-5717</orcidid></search><sort><creationdate>20210601</creationdate><title>Head and neck cancer patients under (chemo-)radiotherapy undergoing nutritional intervention: Results from the prospective randomized HEADNUT-trial</title><author>Löser, Anastassia ; Abel, Jakob ; Kutz, Laura Magdalena ; Krause, Linda ; Finger, Anna ; Greinert, Franziska ; Sommer, Margaret ; Lorenz, Tessa ; Culmann, Eva ; von Grundherr, Julia ; Wegert, Luisa ; Lehmann, Loreen ; Matnjani, Gesa ; Schwarz, Rudolf ; Brackrock, Sophie ; Krüll, Andreas ; Petersen, Cordula ; Carl, Cedric Oliver</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c428t-21ff84e67e327ff4537c2a57a51e8d3d91eb446f6153817a89c6daf5c87a428c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Bioelectric impedance analysis</topic><topic>Head and neck cancer</topic><topic>Malnutrition</topic><topic>Survival</topic><topic>Toxicity</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Löser, Anastassia</creatorcontrib><creatorcontrib>Abel, Jakob</creatorcontrib><creatorcontrib>Kutz, Laura Magdalena</creatorcontrib><creatorcontrib>Krause, Linda</creatorcontrib><creatorcontrib>Finger, Anna</creatorcontrib><creatorcontrib>Greinert, Franziska</creatorcontrib><creatorcontrib>Sommer, Margaret</creatorcontrib><creatorcontrib>Lorenz, Tessa</creatorcontrib><creatorcontrib>Culmann, Eva</creatorcontrib><creatorcontrib>von Grundherr, Julia</creatorcontrib><creatorcontrib>Wegert, Luisa</creatorcontrib><creatorcontrib>Lehmann, Loreen</creatorcontrib><creatorcontrib>Matnjani, Gesa</creatorcontrib><creatorcontrib>Schwarz, Rudolf</creatorcontrib><creatorcontrib>Brackrock, Sophie</creatorcontrib><creatorcontrib>Krüll, Andreas</creatorcontrib><creatorcontrib>Petersen, Cordula</creatorcontrib><creatorcontrib>Carl, Cedric Oliver</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Radiotherapy and oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Löser, Anastassia</au><au>Abel, Jakob</au><au>Kutz, Laura Magdalena</au><au>Krause, Linda</au><au>Finger, Anna</au><au>Greinert, Franziska</au><au>Sommer, Margaret</au><au>Lorenz, Tessa</au><au>Culmann, Eva</au><au>von Grundherr, Julia</au><au>Wegert, Luisa</au><au>Lehmann, Loreen</au><au>Matnjani, Gesa</au><au>Schwarz, Rudolf</au><au>Brackrock, Sophie</au><au>Krüll, Andreas</au><au>Petersen, Cordula</au><au>Carl, Cedric Oliver</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Head and neck cancer patients under (chemo-)radiotherapy undergoing nutritional intervention: Results from the prospective randomized HEADNUT-trial</atitle><jtitle>Radiotherapy and oncology</jtitle><addtitle>Radiother Oncol</addtitle><date>2021-06-01</date><risdate>2021</risdate><volume>159</volume><spage>82</spage><epage>90</epage><pages>82-90</pages><issn>0167-8140</issn><eissn>1879-0887</eissn><abstract>•Nutritional status impacts outcome of patients with head and neck cancer after (chemo-)radiotherapy.•Parameters from bioelectric impedance analysis may serve as indicators for overall survival.•So-called phase angle and fat-free mass index from bioelectric impedance analysis may predict overall survival in head and neck cancer patients after (chemo-)radiotherapy.•Albumin at the end of (chemo-)radiotherapy predicts overall survival in head and neck cancer patients after (chemo-)radiotherapy.
Patients with squamous cell carcinoma of the head and neck undergoing (chemo-)radiotherapy are at high risk of malnutrition. Nevertheless, there is still a lack of prospective, randomized trials investigating the influence of nutritional status on therapy-related toxicity and patients’ outcome.
Between October 2018 and October 2020, 61 patients were randomized into an intervention and control group. Questionnaires (MUST, NRS-2002, and Nutriscore), clinical examinations, laboratory analyses, and bioelectrical impedance analysis (BIA) were used to assess nutritional status for all patients at the beginning and end of therapy as well as every 2 weeks during therapy. The intervention consisted of an individualized nutritional counseling every 2 weeks during therapy.
Median baseline BMI for all participants was 23.8 (14.5–37.2) kg/m2 and dropped to 22.9 (16.8–33) kg/m2 after therapy (p < 0.001). In all patients, median baseline fat-free mass index (FFMI) was 18.1 (14–24.7) kg/m2 and decreased to 17.8 (13.4–21.6) kg/m2 till the end of therapy (p < 0.001). Compliant patients with a BMI < 22 kg/m2 presented with less weight loss in the intervention group compared to the control (p = 0.015, CI: 0.33–2.95). At baseline, MUST was the only screening-test which showed both good sensitivity (86%) and specificity (88%) in detecting malnutrition. Median follow-up was 15 (1–26) months and is still ongoing. 2-year overall survival rate was 70% in the control and 79% in the intervention group (log-rank p = 0.79). Pretherapeutic phase angle, posttherapeutic FFMI and albumin level were prognostic indicators for overall survival (log-rank p = 0.002, p = 0.008 and p = 0.016).
Malnutrition negatively impacts patients’ outcome under (chemo-)radiotherapy. Baseline phase angle, posttherapeutic FFMI and albumin level are proposed as reliable indicators for overall survival.
This study was registered within the German Clinical Trials Register (DRKS00016862).</abstract><cop>Ireland</cop><pub>Elsevier B.V</pub><pmid>33766702</pmid><doi>10.1016/j.radonc.2021.03.019</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-8324-5884</orcidid><orcidid>https://orcid.org/0000-0003-4981-7217</orcidid><orcidid>https://orcid.org/0000-0003-0466-4712</orcidid><orcidid>https://orcid.org/0000-0002-8490-5717</orcidid></addata></record> |
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| subjects | Bioelectric impedance analysis Head and neck cancer Malnutrition Survival Toxicity |
| title | Head and neck cancer patients under (chemo-)radiotherapy undergoing nutritional intervention: Results from the prospective randomized HEADNUT-trial |
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