Search

Critical weight loss (CWL) continues to be a major issue in head and neck cancer (HNC) and many patients require tube feeding. We investigated the use of reactive feeding tubes (RFTs), associated CWL, and the impact on cancer-specific survival (CSS). A single-institution, retrospective audit was conducted on 460 adult HNC patients who received radiotherapy ± chemotherapy between 2005 and 2017. CSS in patients with CWL and RFTs was compared to those with no tube. Prediction analysis for RFT insertion was also performed. CWL occurred in 53% of patients, and in 88% of those with a RFT (p < 0.001). In patients with CWL, those with a RFT had worse 5 and 10-year CSS compared to those with no tube (68% and 65% vs 83% and 80% respectively, p = 0.040) in multivariate Cox regression analysis. Concurrent chemoradiotherapy combined with CWL was the strongest predictor for RFT insertion (p = 0.003). CWL, combined with having a RFT, impacts negatively on CSS. CWL may be one of the triggers for RFT insertion, however those with no tube have better CSS. This may be due to higher weight loss levels seen in those who have a RFT, and earlier insertion to prevent such losses seems indicated. [ABSTRACT FROM AUTHOR]

Critical weight loss (CWL) defined as ≥5% in one month, is common in patients with oropharynx cancer and identification of patients at risk is challenging. We aimed to investigate if predictors of CWL in this population exist to guide nutritional intervention. Data were collected retrospectively on 134 patients who had radiotherapy (RT) ± concurrent chemotherapy (CRT) ± surgery. Body weights were collected pre-RT and during RT, with percentage weight change measured against baseline. Logistic regression was used to analyze chosen predictors. The incidence of CWL was 67% (26% of these patients experiencing ≥10% loss). Patients who had CRT experienced significantly higher weight loss (7.1% versus 4.7%;p= 0.001). Tube feeding was used in 64% of patients with CWL, the majority of tubes inserted reactively. These patients had a mean weight change of −8.8% (versus −7.1% in those with no tube) (p= 0.004). Multivariate models identified increased risk of CWL in tonsil origin tumors (p< 0.05), with CRT being the only predictor of weight loss ≥10% (p< 0.05). These patients are particularly vulnerable to CWL and the majority experience significant nutritional issues during RT, regardless of nutritional status at diagnosis. Nutritional intervention should be targeted accordingly. [ABSTRACT FROM PUBLISHER]

Introduction: To evaluate the care and outcomes for patients presenting with floor of mouth (FOM) cancers. Methods: In this Ethics-approved audit, all eligible patients were evaluated with eligibility defined as having a squamous cell carcinoma originating in the FOM. Patient, disease and treatment factors were defined. Primary end points were ultimate local/regional control and cancer-specific survival. These were analysed according to the Kaplan-Meier method. The log-rank test was used to determine statistical significance between survival curves. Multivariate analysis was conducted using Cox regression. Results: A total of 157 patients were eligible for analysis, 76% males and 24% females, with 38 (24%) having a prior diagnosis of cancer. Surgery was performed in 126 patients (54 with pre/postoperative radiotherapy), radiotherapy only in 30 patients and chemotherapy only in 1 patient. Surgery had the best local control (85%), with 23/30 (77%) patients having radiotherapy failing locally. Ultimate regional control was achieved in 89% of patients, while new primaries occurred in 45 (29%) Conclusions: Surgery remains an essential component of the treatment of patients with FOM cancers, with a high likelihood of other cancers developing. [ABSTRACT FROM AUTHOR]

Background Early glottic carcinoma has a high local control prospect with radiotherapy. This review evaluates a single center's experience. Methods All patients from 1967 to 2006 diagnosed with Tis/T1/T2/N0 early glottic carcinoma treated definitively with radiotherapy at Prince of Wales Hospital were reviewed. Local control and cancer-specific survival (CSS) rates were primary endpoints, and the impact of various factors on these outcomes was statistically analyzed. Results This review of 522 patients includes 24 with Tis, 356 with T1, and 142 with T2. Ultimate local control rates were as follows: Tis 87.5%, T1 94.7%, and T2 84.5%. Multivariate analysis found fitness for surgery, no involvement of anterior commissure, normal cord movement, and radiotherapy dose >60 Gy significant for local control. Fitness for surgery, no involvement of the anterior commissure, normal cord movement, and no ventricular involvement were significant prognostic factors for CSS. Conclusion Definitive radiotherapy for early glottic carcinoma provides high local control rates, with the option of surgical salvage to achieve ultimate local control. © 2009 Wiley Periodicals, Inc. Head Neck, 2010 [ABSTRACT FROM AUTHOR]