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


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.
Lin
Alexander
A
Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109-0010, USA.
Jabbari
Siavash
S
Worden
Francis P
FP
Bradford
Carol R
CR
Chepeha
Douglas B
DB
Teknos
Theodoros N
TN
Liao
Jay J
JJ
Nyquist
Gurston G
GG
Tsien
Christina
C
Schipper
Matthew J
MJ
Urba
Susan
S
Wolf
Gregory T
GT
Eisbruch
Avraham
A
D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001806:Blood Urea Nitrogen; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D003404:Creatinine / Q000378:metabolism*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000532:radiotherapy*; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology / Q000528:radiation effects; D008297:Male; D009061:Mouth Mucosa / Q000187:drug effects / Q000528:radiation effects; D012074:Remission Induction; D012189:Retrospective Studies; D013280:Stomatitis / Q000209:etiology; D015431:Weight Loss
D003404:Creatinine; D002945:Cisplatin; D005472:Fluorouracil