Background: The interaction of pre-treatment weight loss and severe malnutrition manifested during chemo-irradiation for Stage III and IV squamous cell carcinoma of the head and neck (SCCHN) with therapeutic outcomes and survival is not clear from the literature. Severe weight loss is observed frequently in these patients and many invasive and costly interventions are performed to combat malnutrition during cancer treatment. The objective of this investigation was to determine the importance of weight loss before and during concomitant chemotherapy and radiation therapy for advanced operable SCCHN on treatment response and survival.
Methods: Records of 78 patients with Stage III and IV, clinically operable squamous cell carcinoma of the head and neck (SCCHN) who underwent radiotherapy and concomitant chemotherapy of any type (TREATMENT) were examined retrospectively in two groups: <7.5% weight loss in 3 months (Non-Severe Treatment Weight Loss (NSTWL); n=17) and >7.5% loss (Severe Treatment Weight Loss (STWL); n=61), per ADA definitions of severe malnutrition for acute illness. Data included self-reported pre-treatment weight loss, tumor site, grade, stage, TREATMENT toxicity, response (CCR = Clinical Complete; HCR = Histologic Complete with no residual tumor), surgeries performed, recurrence, survival, and Disease status upon expiration. Statistics were by Chi-squared, ANOVA, and Kaplan-Meier.
Results: Per study design, % weight loss during TREATMENT was greater in the STWL group than NSTWL (-17.4% +-8.0% versus -0.1% +-6.4%, p<0.0001). Pre-Treatment weight was higher in the STWL group than the NSWL group (179.4+ 41.4lbs vs 131.8+ 28.1lbs, p<0.0001). Age at diagnosis was younger in STWL than in NSTWL (59.9 + 10.8yrs versus 65.7 + 8.52yrs, p=0.0447). Between NSTWL and SRWL, patient-reported pre-treatment weight loss (42.6% vs 47.1%, p=0.74), primary tumor site, Stage, tumor grade, and toxicity to TREATMENT did not vary significantly. CCR was achieved in 5/15(33%) of NSTWL patients and in 38/58 (65%) of STWL (P=0.024). HCR was confirmed in 5/5 NSTWL and 36/37 STWL CCR patients who underwent post-TREATMENT biopsy. SCCHN recurred in 9/14 (64.3%) of NSTWL and 24/58 (41.4%) of STWL patients (p=0.12). All recurrences were local. Kaplan-Meier curves are displayed in the Figure. Both survival overall (p<0.001) and disease-free survival (p<0.003) were greater among STWL compared with NSTWL.
Conclusions: Severe weight loss during TREATMENT for advanced Stage III and Stage IV SCCHN is associated with increased Overall and Disease Free Survival. The incidence of pre-treatment weight loss did not vary between the STWL and NSTWL groups. These findings identify a beneficial biologic interaction between TREATMENT-related host severe weight loss and SCCHN tumor response to chemo-irradiation, cancer recurrence, and long-term survival. The mechanism driving this phenomenon is not clear from the data.