Department of Nutrition and Dietetics, VU University Medical Center, Amsterdam, The
Radiother Oncol. 2010 Oct;97(1):80-5. doi: 10.1016/j.radonc.2010.02.017. Epub 2010 Mar 10.
Although patients with early stage (T1/T2) laryngeal cancer (LC) are thought to have a low incidence of malnutrition, severe weight loss is observed in a subgroup of these patients during radiotherapy (RT). The objective of this study was to evaluate weight loss and nutrition-related symptoms in patients with T1/T2 LC during RT and to select predictive factors for early identification of malnourished patients.
Of all patients with T1/T2 LC, who received primary RT between 1999 and 2007, the following characteristics were recorded: sex, age, TNM classification, tumour location, radiation schedule, performance status, quality of life, weight loss, and nutrition-related symptoms. The association between baseline characteristics and malnutrition (>5% weight loss during RT) was investigated by Cox regression analysis.
The study population consisted of 238 patients. During RT, 44% of patients developed malnutrition. Tumour location, TNM classification, RT on the neck nodes, RT dose, nausea/vomiting, pain, swallowing, senses problems, trouble with social eating, dry mouth and the use of painkillers were all significantly associated with malnutrition. In the multivariate analysis, RTs on both the neck nodes (HR 4.16, 95% CI 2.62-6.60) and dry mouth (HR 1.72, 95% CI 1.14-2.60) remained predictive. Nevertheless, RT on the neck nodes alone resulted in the best predictive model for malnutrition scores.
Patients with early stage laryngeal cancer are at risk of malnutrition during radiotherapy. Radiotherapy on the neck nodes is the best predictor of malnutrition during radiotherapy. Therefore, we suggest to offer nutritional counselling to all the patients who receive nodal irradiation.
尽管早期（T1/T2）喉癌（LC）患者被认为营养不良发生率较低，但在这些患者的亚组中，在放射治疗（RT）期间会观察到严重的体重减轻。本研究的目的是评估 T1/T2LC 患者在 RT 期间的体重减轻和与营养相关的症状，并选择预测因子以早期识别营养不良患者。
在 1999 年至 2007 年间接受原发性 RT 的所有 T1/T2LC 患者中，记录了以下特征：性别、年龄、TNM 分类、肿瘤位置、放疗方案、身体状况、生活质量、体重减轻和与营养相关的症状。通过 Cox 回归分析调查基线特征与营养不良（RT 期间体重减轻>5%）之间的关联。
该研究人群由 238 例患者组成。在 RT 期间，44%的患者出现营养不良。肿瘤位置、TNM 分类、颈部淋巴结放疗、放疗剂量、恶心/呕吐、疼痛、吞咽困难、感觉问题、社交进食困难、口干和止痛药的使用均与营养不良显著相关。在多变量分析中，颈部淋巴结放疗（HR 4.16，95%CI 2.62-6.60）和口干（HR 1.72，95%CI 1.14-2.60）仍然具有预测作用。然而，颈部淋巴结放疗单独导致了营养不良评分的最佳预测模型。
早期喉癌患者在放疗期间有发生营养不良的风险。颈部淋巴结放疗是预测放疗期间营养不良的最佳指标。因此，我们建议为所有接受淋巴结照射的患者提供营养咨询。
