Fange Gjelstad Ingrid M, Lyckander Christian, Høidalen Anne, Bratland Åse, Blomhoff Rune, Paur Ingvild, Henriksen Christine
Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway.
Department of Nutrition, Institute of Basic Medical Science, University of Oslo, Oslo, Norway.
Clin Nutr ESPEN. 2025 Feb;65:390-399. doi: 10.1016/j.clnesp.2024.12.019. Epub 2024 Dec 20.
Patients with head and neck cancer (HNC) undergoing radiotherapy or chemoradiotherapy often experience symptoms that affect their ability to eat. This study aimed to explore the impact of radiotherapy on body weight in HNC patients and compare the characteristics of patients receiving enteral tube feeding with those maintaining an oral diet.
In this prospective study, 52 patients with HNC were examined at diagnosis, at the start and end of radiotherapy, and six weeks after end of treatment. The nutritional assessment included measurements of body weight, food intake, and malnutrition using Patient-Generated Subjective Global Assessment (PG-SGA). Other variables were retrieved from the electronic patient record.
Critical weight loss (defined as >5 % from start of radiotherapy) was present in 60 % of the patients at the end of radiotherapy, and only half of these patients received any enteral nutrition therapy. The mean weight loss was 5.8 % during radiotherapy, and an additional 2.1 % at follow-up (n = 48). A nasogastric feeding tube was used by 42 % at the end of radiotherapy, and 29 % at follow-up. The tube feeding users had a lower energy intake and higher weight loss than non-tube feeding users (22 vs 27 kcal/kg body weight, 7.8 vs 4.4 % weight loss) at the end of radiotherapy treatment. According to PG-SGA, 92 % of the patients were malnourished at the end of treatment and 71 % at follow-up (p < 0.001).
Critical weight loss and malnutrition were common in HNC patients after radiotherapy, and enteral tube feeding was initiated in only half of the cases with critical weight loss. Patients receiving enteral tube feeding may need closer monitoring to ensure adequate energy intake, and other treatment options may be necessary. These results emphasize the need for improved nutritional intervention during and after radiotherapy.
接受放疗或放化疗的头颈癌（HNC）患者常出现影响其进食能力的症状。本研究旨在探讨放疗对HNC患者体重的影响，并比较接受肠内管饲的患者与维持经口饮食的患者的特征。
在这项前瞻性研究中，对52例HNC患者在诊断时、放疗开始和结束时以及治疗结束后六周进行检查。营养评估包括使用患者主观整体评定法（PG-SGA）测量体重、食物摄入量和营养不良情况。其他变量从电子病历中获取。
放疗结束时，60%的患者出现严重体重减轻（定义为自放疗开始后体重下降>5%），而这些患者中只有一半接受了任何肠内营养治疗。放疗期间平均体重减轻5.8%，随访时又额外减轻2.1%（n = 48）。放疗结束时42%的患者使用鼻胃饲管，随访时为29%。在放疗治疗结束时，使用管饲的患者能量摄入量较低，体重减轻幅度较大，高于未使用管饲的患者（分别为22 vs 27 kcal/kg体重，体重减轻7.8% vs 4.4%）。根据PG-SGA，92%的患者在治疗结束时营养不良，随访时为71%（p < 0.001）。
放疗后HNC患者中严重体重减轻和营养不良很常见，严重体重减轻的患者中只有一半开始接受肠内管饲。接受肠内管饲的患者可能需要更密切的监测以确保足够的能量摄入，可能还需要其他治疗选择。这些结果强调了放疗期间及放疗后改善营养干预的必要性。
