Metabolic abnormalities associated with weight loss during chemoirradiation of head-and-neck cancer

Alexander Lin, Siavash Jabbari, Francis P. Worden, Carol R. Bradford, Douglas B. Chepeha, Theodoros N. Teknos, Jay J. Liao, Gurston G. Nyquist, Christina Tsien, Matthew J. Schipper, Susan Urba, Gregory T. Wolf, Avraham Eisbruch

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Weight loss caused by acute mucositis and dysphagia is common during concurrent chemoirradiation (chemo-RT) of head-and-neck (HN) cancer. The metabolic consequences of weight loss during chemo-RT were investigated. Patients and Methods: Ninety-six patients with locally advanced HN cancer were treated from 1995 to 2001 on protocols that consisted of 1 to 2 cycles of induction cisplatin/5-fluorouracil followed by irradiation (70 Gy over 7 weeks) concurrent with cisplatin (100 mg/m2 every 3 weeks). Body weights and metabolic evaluations were obtained before and during induction chemotherapy and chemo-RT. Greatest percent changes in weight and in the laboratory values were calculated for each phase of therapy. Results: During induction chemotherapy, significant changes were found in BUN, BUN:creatinine ratio, HCO3, Mg, and albumin, but not in creatinine, Na, K, or weight. During chemo-RT, significant additional changes were observed in all parameters measured, including increases in BUN, creatinine, BUN: creatinine ratio, and HCO3 and decreases in Mg, albumin, Na, K, and weight. The magnitude of most of these changes was significantly greater during chemo-RT than during induction chemotherapy. During chemo-RT, 35% of the patients had more than 10% body weight loss and 6 patients had an increase in creatinine of more than 100%, including 5 patients with Grade 2 nephrotoxicity, all of whom had weight loss 10% or more. Significant correlations were found between weight loss and creatinine (p < 0.0001) or BUN (p = 0.0002) rises, but not with BUN:creatinine ratio or other metabolic changes. Age, gender, tobacco history, hypertension, and diabetes mellitus were not significant predictors of nephrotoxicity. Conclusions: Weight loss during cisplatin-containing chemo-RT was found to be associated with reduced kidney function. These findings do not establish cause-effect relationships; however, they highlight the importance of intensive supportive measures of nutrition and hydration beyond standard hydration during cisplatin administration. These intensive measures should be enacted before a 10% weight loss is reached.

Original languageEnglish (US)
Pages (from-to)1413-1418
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume63
Issue number5
DOIs
StatePublished - Dec 1 2005
Externally publishedYes

Keywords

  • Chemotherapy
  • Cisplatin
  • Head-and-neck cancer
  • Nephropathy
  • Nutrition
  • Radiotherapy
  • Weight loss

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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