[Value of megestrol acetate in treatment of cachexia in head-neck tumors].

Mortality of 70% of all patients with tumors in the head and neck is linked with anorexia and cachexia. Two reasons for cachexia are well known: 1. local disease and local therapy preventing oral nutrition and 2. advanced tumors activating biochemical pathways of proteolysis, lipolysis, and gluconeogenesis. Five groups of substances are now used to treat tumor-induced cachexia: corticosteroids, progestational drugs, cyproheptadine, hydrazine sulfate, and anabolic steroids. Between 1992 and 1993 we treated 38 patients suffering from cachexia due to advanced cancers of the head and neck with 160 mg megestrol acetate per day for four months. The increase in body weight was significant after eight weeks. The mean increase after full therapy was 4.58 +/- 3.19 kg. Treatment of the five women in the series was very successful and all achieved their former body weight. Megestrol acetate therapy was best started after assuring enteral nutrition. Significant adverse events were loss of libido for the men, headache and, rarely, thrombophlebitis. Our first experiences suggest that megestrol acetate treatment is useful in cachectic patients with advanced squamous cell carcinomas of the head and neck.