Kapała Aleksandra, Surwiłło-Snarska Agnieszka, Jodkiewicz Magdalena, Kawecki Andrzej
Department of Clinical Nutrition, Head and Neck Cancer Department, Maria Sklodowska-Curie National Research Institute of Oncology, 02781 Warsaw, Poland.
Department of Clinical Nutrition, Maria Sklodowska-Curie National Research Institute of Oncology, 02781 Warsaw, Poland.
Cancers (Basel). 2021 May 21;13(11):2532. doi: 10.3390/cancers13112532.
The treatment of locally advanced head and neck cancer (HNC) is based on extensive resections followed by concurrent chemoradiotherapy (CRT) with platinum derivatives or concurrent radiotherapy with cetuximab (bioradiotherapy; BRT). Malnutrition, which occurs in up to 60% of patients before treatment commencement, severely increases the risk of CRT/BRT drug dose reductions and the incidence of treatment-related adverse events. A prospective observational study was performed regarding the influence of nutritional care on nutritional status, compliance with the treatment's planned regimen, and the incidence of treatment-related complications in patients with advanced HNC during CRT and BRT. The study population encompassed 153 patients compared with a retrospective control group of 72 patients treated before nutritional care was included in the standard of oncological care. Patients enrolled in the nutritional care programme received significantly higher doses of platinum derivatives or cetuximab than patients in the control group. A significant difference between the compared populations was observed in patients below 70 years of age (92.8% of the study population), after prior surgery, and with initial weight loss lower than 10%. Nutritional care reduced final weight loss and prevented a decline within the laboratory markers of nutritional status. Weight loss was comparable in both modes of treatment-CRT and BRT. The incidence of treatment-related complications was significantly higher in patients without nutritional support in the subgroups of patients under 70 years of age and after primary surgery. Nutritional care before and during CRT and BRT in patients with HNC is a determinant of therapeutic benefit, defined as preventing down-dosing, weight loss, and the incidence of complications. Platinum derivatives and cetuximab had comparable influence on weight loss.
局部晚期头颈癌（HNC）的治疗基于广泛切除，随后进行铂类衍生物同步放化疗（CRT）或西妥昔单抗同步放疗（生物放疗；BRT）。营养不良在高达60%的患者治疗开始前就已出现，严重增加了CRT/BRT药物剂量减少的风险以及治疗相关不良事件的发生率。针对营养护理对晚期HNC患者在CRT和BRT期间营养状况、治疗计划方案依从性以及治疗相关并发症发生率的影响进行了一项前瞻性观察研究。研究人群包括153例患者，与一个72例患者的回顾性对照组进行比较，该对照组患者在营养护理纳入肿瘤护理标准之前接受治疗。参与营养护理计划的患者比对照组患者接受了显著更高剂量的铂类衍生物或西妥昔单抗。在70岁以下患者（占研究人群的92.8%）、先前手术后以及初始体重减轻低于10%的患者中，观察到比较人群之间存在显著差异。营养护理减少了最终体重减轻，并防止了营养状况实验室指标的下降。CRT和BRT两种治疗方式下的体重减轻情况相当。在70岁以下患者亚组和初次手术后，没有营养支持的患者治疗相关并发症的发生率显著更高。HNC患者在CRT和BRT之前及期间的营养护理是治疗获益的决定因素，治疗获益定义为防止剂量减少、体重减轻和并发症的发生。铂类衍生物和西妥昔单抗对体重减轻的影响相当。
