Introduction: Acute radiation toxicity is a limiting factor of radiotherapy for head and neck cancers. This acute toxicity depends on number of factors like dose of radiation, dose per fraction, total dose, treatment portals, machines used etc. Nutritional status (NS) of the patient is also an important factor of head and neck cancer so far, development of acute toxicity and tolerance is concerned. Keeping other variables unchanged, how NS affects radiation induced toxicity was the main object of the study.
Patients and Methods: Total 280 patients of squamous cell carcinoma of upper aero‐digestive tract were selected for the study. NS of all patients were calculated. The degree of acute toxicity during the course of radiation and 3 weeks after completion of external radiation were noted. The acute toxicity was recorded as per RTOG acute toxicity criteria.
NS is assessed by 1. clinical examination, 2. anthropometric measurement, 3. biochemical investigations, 4. hematological examinations, 5. dietetic assessment.
Anthropometric measurement done by: 1. weight (kg), 2. height (cm), 3. wrist circumference, 4. waist circumference, 5. waist: hip ratio, 6. body mass index = weight (kg) height2 (m2), 7. triceps skin fold thickness. Biochemical Estimation is done by: 1. serum albumin, 2. serum transferrin, 3. serum ceruloplasmin.
Immunologicalparameters are: 1. total circulating lymphocyte count (more than 2000 cells / cu mm normal value, 1200 – 2000 cells / cu mm mild malnutrition, 800 – 1200 cells / cu mm moderate malnutrition, less than 800 cells / cu mm severe malnutrition), 2. delayed cutaneous hypersensitivity (DCH) test, 3. DNCB challenge test, 4. Mantoux test
Acute radiation morbidity scoring was done as per criteria (RTOG).
Result Analysis: There was significantly increased toxicity in patients who were poorly nutritious (n=135) as compared to those who were normally nourished (n=88). Those patients who were under nutritious also showed poor standard of oral hygiene. Rest 57 patients NS were undetermined and were excluded from evaluation. In under nutritious group, acute radiation toxicity grading was: Gr.1 (0%), Gr.2 (42.96%), Gr.3 (55.55%), & Gr.4 (1.48%) respectively. On the contrary, the normal nutritious group acute toxicity developed Gr.1 (11.36%), Gr.2 (81.81%), Gr.3 (6.81%) & Gr.4 (0%) respectively. Oral hygiene of poor standard was 12.5% in under nutritious patients and 4.5% in normal nutritious patients.
Conclusion: Aim of this paper lies in its attempt to explore the acceptability of “Nutritional Status” as a variable in development of radiation induced toxicity, as far as acute morbidity is concerned. In that sense it is a successful phase I trial. One can conclude that there exists some correlation between radiation morbidity and NS of the patients. Therefore correction of NS before onset of radiation provides better tolerance to radiotherapy.
Citation Information: Cancer Prev Res 2010;3(1 Suppl):A142.