Atasoy Beste M, Demirel Birsen, Ekşi Özdaş Feyza Nur, Devran Bennur, Kılıç Zehra Nur, Gül Dilek
Department of Radiation Oncology, Marmara University School of Medicine, Istanbul, Türkiye.
S.B.-M.Ü. Pendik Eğitim ve Arastırma Hastanesi Radyasyon Onkolojisi Klinigi, Fevzi Cakmak Mah. Muhsin Yaziciıoglu cad. No: 6, Pendik/Istanbul, 34899, Türkiye.
Radiat Oncol. 2025 May 3;20(1):70. doi: 10.1186/s13014-025-02645-4.
Adaptive treatment planning can be made in radiotherapy of head and neck cancer patients for reasons such as changes in tumor volume or weight loss. This study aims to find the role of treatment planning images in monitoring radiotherapy-induced malnutrition and predicting the malnutrition-induced prognosis in head and neck cancer patients.
For this study, we analyzed 30 patients who received radiotherapy in our clinic between September 2018 and September 2021. Those patients, both regular and completed weekly dietitian counseling notes during radiotherapy and available adaptive radiotherapy planning images, were included in the analysis. All patients had weekly nutritional interventions, including nutritional and anthropometric changes in weight, height, body mass index (BMI), and lean body mass (LBM). Skeletal muscle volume, called cervical muscle gauge (CMG), was measured from the simulation images of beginning and adaptive radiotherapy. Inflammatory parameters, including the neutrophil-lymphocyte ratio (NLR), the platelet-lymphocyte ratio (PLR), and the systemic inflammatory index (SII), were also calculated from weekly total blood counts. For the analysis, anthropometric measurements were compared at the beginning and adaptive treatment time. Progression-free (PFS) and overall (OS) survival were calculated according to weight and CMG changes.
The median weight loss percentage was 4.8% (0 to 24%). The mean percentage of weight changes, LBM, and CMG were 6.33%, 3.47%, and 9.28%, respectively. Results indicated that BMI (p = 006), weight (p < 0.001), LBM (p < 0.001), and CMG (p = 0.057) decreased during radiotherapy. Hemoglobin levels decreased (p = 0.005), and inflammatory markers increased. There were significant correlations between weight and LBM (p < 0.0001) and CMG (p = 0.005) loss. The median follow-up was 26 months. Loss of weight (PFS; 65.5% vs. 35.7%, p = 0.09, OS; 73.7% vs. 32.1%, p = 0.09), LBM (PFS; 75% vs. 41.1%, p = 0.118, OS; 65.6% vs. 52%, p = 0.221) and CMG (PFS; 56.3% vs. 47.1%, p = 0.516, OS;76.9% vs. 32.4%, p = 0.059) negatively affected three-year survival.
Cervical muscle volume measurement may help predict malnutrition in patients receiving radiotherapy for head and neck cancer. Our study shows adaptive planning images may be used for this approach. In addition, this method may help to predict prognosis due to malnutrition in patients undergoing radiotherapy.
头颈部癌患者在放疗过程中，由于肿瘤体积变化或体重减轻等原因，可以进行适应性治疗计划。本研究旨在探讨治疗计划图像在监测头颈部癌患者放疗引起的营养不良以及预测营养不良所致预后方面的作用。
本研究分析了2018年9月至2021年9月期间在我院接受放疗的30例患者。纳入分析的患者需有放疗期间定期且完整的营养师咨询记录以及可用的适应性放疗计划图像。所有患者均接受每周一次的营养干预，包括体重、身高、体重指数（BMI）和去脂体重（LBM）的营养和人体测量变化。从初始放疗和适应性放疗的模拟图像中测量骨骼肌体积，即颈肌测量值（CMG）。还根据每周的全血细胞计数计算炎症参数，包括中性粒细胞与淋巴细胞比值（NLR）血小板与淋巴细胞比值（PLR）和全身炎症指数（SII）。分析时，比较初始治疗和适应性治疗时的人体测量数据。根据体重和CMG变化计算无进展生存期（PFS）和总生存期（OS）。
体重减轻百分比中位数为4.8%（0至24%）。体重、LBM和CMG变化的平均百分比分别为6.33%、3.47%和9.28%。结果表明，放疗期间BMI（p = 0.06）、体重（p < 0.001）、LBM（p < 0.001）和CMG（p = 0.057）均下降。血红蛋白水平下降（p = 0.005），炎症标志物升高。体重与LBM（p < 0.0001）和CMG（p = 0.005）的丢失之间存在显著相关性。中位随访时间为26个月。体重减轻（PFS：65.5%对35.7%，p = 0.09；OS：73.7%对32.1%，p = 0.09）、LBM（PFS：75%对41.1%，p = 0.118；OS：65.6%对52%，p = 0.221）和CMG（PFS：56.3%对47.1%，p = 0.516；OS：76.9%对32.4%，p = 0.059）对三年生存率有负面影响。
颈肌体积测量可能有助于预测接受头颈部癌放疗患者的营养不良情况。我们的研究表明适应性计划图像可用于此方法。此外，该方法可能有助于预测放疗患者因营养不良导致的预后。
