917P - Head and neck cancer patients under (chemo-)radiotherapy undergoing nutritional intervention: Results from the prospective randomized HEADNUT-trial

Background

Patients with head and neck squamous cell carcinoma (HNSCC) are often malnourished before starting the primary or adjuvant radiotherapy (RT) or chemoradiotherapy (CRT). Due to therapy related adversary effects of the RT or CRT the number of malnourished patients rises to 88% during ongoing therapy. Malnutrition can have a negative influence on therapycourse and clinical outcome. There are still not enough prospective, randomized studies on the influence of nutritional status on adversary effects of (C-)RT during therapy.

Methods

From October 2018 to October 2020, the nutritional status of 61 patients with HSNCC, randomized into a control and intervention group (IG), was measured at the beginning, every 2 weeks during and at the end of therapy. The risk of malnutrition was evaluated with established malnutrition screening tools (NRS-2002, MUST, Nutriscore) and 3-day diet diaries, patients underwent clinical examinations, laboratory analyses and bioelectrical impedance analyses. In addition, the IG had individualized nutritional counseling every 2 weeks.

Results

Before therapy, the median BMI of all patients was 23.8 (14.5-37.2) kg/m² and after therapy median BMI fell to 22.9 (16.8-33) kg/m² (p<0.001). The baseline median fat-free mass index (FFMI) for all patients was 18.1 (14-24.7) kg/m², which dropped to 17.8 (13.4-21.6) kg/m² at the ending of therapy (p<0.001). Control group patients lost more weight compared to compliant intervention group participants with a BMI <22 kg/m²(p=0.0015, CI: 0.33-2.95). MUST was the only questionnaire, which showed high sensitivity (86%) and specificity (88%) at baseline in predicting malnutrition. The 2-year overall survival rate was 70% in the control group 79% in the intervention group (log-rank p=0.79). A clear impact on the overall survival rate was observed in pretherapeutic phase angle, posttherapeutic FFMI and albumin level in blood as indicators (log-rank p=0.002, p=0.008, p=0.016).

Conclusions

Malnutrition has an adverse impact on patients’ outcome undergoing (chemo-) radiotherapy. Pretherapeutic phase angle, posttherapeutic FFMI and albumin level can be considered as indicators for overall survival.

Clinical trial identification

DRKS00016862.

Editorial acknowledgement

Legal entity responsible for the study

Dr. Anastassia Löser.

Funding

Has not received any funding.

Disclosure

The author has declared no conflicts of interest.