Evaluating predictive factors for determining enteral nutrition in patients receiving radical radiotherapy for head and neck cancer: a retrospective review.
OBJECTIVE
To identify objective pre-treatment clinical parameters that could be used to predict for patients at high risk of requiring enteral tube feeding prior to head and neck radiotherapy.


METHODS
A retrospective study was conducted on 160 consecutive patients attending for radiotherapy assessment. Regression analysis was used to determine various pre-treatment nutritional and tumour specific parameters associated with the use of enteral nutrition either before (prophylactic) or during (reactive) radiotherapy (RT). The significant parameters identified were then selected into categorical variables and compared between those who needed reactive enteral nutrition and the remainder of the group who did not. These results were used to generate predictive factors that could be used to identify those at high risk of malnutrition during RT for whom early or prophylactic enteral nutrition should be considered.


RESULTS
Fifty patients required enteral feeding of which 60% required this prior to radiotherapy. Multivariate analysis identified the following factors to be significant--body mass index, performance status (PS), advanced stage, pre-treatment weight loss, low serum albumin and protein, age, and smoking. The most significant categorical predictive parameters for reactive enteral feeding were stage 3-4 disease, PS 2-3, and smoking >20/day. The combination of these factors predicted a 75% chance of needing enteral nutrition.


CONCLUSIONS
Nutritional assessment is important prior to radiotherapy and is multifactorial. Using a combination of relatively simple and objective parameters, (performance status, smoking and disease stage) it is possible to identify those at high risk of needing enteral nutrition prior to starting RT.
Mangar
Stephen
S
Department of Clinical Oncology, Christie Hospital NHS Trust, Manchester, UK. stephenmangar@supaworld.com
Slevin
Nicholas
N
Mais
Kathleen
K
Sykes
Andrew
A
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001798:Blood Proteins / Q000032:analysis; D015992:Body Mass Index; D015331:Cohort Studies; D004750:Enteral Nutrition; D005544:Forecasting; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000532:radiotherapy; D044342:Malnutrition / Q000209:etiology / Q000517:prevention & control; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000532:radiotherapy; D009367:Neoplasm Staging; D015596:Nutrition Assessment; D010610:Pharyngeal Neoplasms / Q000532:radiotherapy; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis; D012720:Severity of Illness Index; D012907:Smoking; D015431:Weight Loss
D001798:Blood Proteins; D012709:Serum Albumin