EATING AND WEIGHT CHANGES FOLLOWING CHEMORADIATION THERAPY FOR ADVANCED HEAD AND NECK-CANCER

Objective: To describe the functional outcomes of weight loss and eati ng following a targeted chemoradiation protocol consisting of a select ive supradose of intra-arterial cisplatin (150 mg/m(2) per week for 4 weeks) with parenteral sodium thiosulfate and external-beam irradiatio n (1.8-2.0 Gy per fraction per day for 35 days). Subjects and Design: Forty-seven patients with advanced head and neck cancer treated with a targeted chemoradiation protocol were monitored for weight and eating status before treatment and as long as 18 months after treatment. Res ults: A statistically significant weight loss (P<.001) occurred during the targeted chemoradiation protocol, with a mean weight ratio of 90% of the starting weight. The ability to eat also declined, with an inc rease in reported swallowing difficulties and a need for percutaneous endoscopic gastrostomy tubes from 4 (9%) to 12 (26%). There were no si gnificant changes in weight after the initial weight loss. Tumor stage and nodal involvement had no effect on weight loss. At the start of t reatment, 18 patients (38%) reported normal eating and 4 (8%) required a feeding tube. By 18 months after treatment, 41 (87%)were eating nor mally, 34 (72%) reported normal eating, and 6 (13%) required a percuta neous endoscopic gastrostomy tube. Conclusions: Patients undergoing a targeted chemoradiation protocol for head and neck cancer lost about 1 0% of their pretreatment weight and had a decline in eating ability. D ifficulty swallowing during the treatment may be due to adverse effect s such as mucositis and nausea. By 18 months after therapy, most were able to eat normally and maintain their weight.