title: Changes in body mass, energy balance, physical function, and inflammatory state in patients with locally advanced head and neck cancer treated with concurrent chemoradiation after low-dose induction chemotherapy.
abstract: BACKGROUND
  We aimed to determine changes in body mass and body composition in relation to energy balance, inflammatory state, and physical function before and after concurrent chemoradiation (CCR).
  
  
  METHODS
  Seventeen patients with stage III and IVa head and neck cancer, aged 58.9 +/- 5.4 years, who had completed a 9-week regimen of low-dose induction chemotherapy came to the General Clinical Research Center pre- and post-CCR for measurement of body mass composition by dual-energy X-ray absorptiometry, resting energy expenditure (REE) by indirect calorimetry, physical performance (by Modified Baecke Questionnaire and Reuben's Physical Performance Test), and functionality (Activities and Instrumental Activities of Daily Living scores). Fasting venous samples were collected to determine C-reactive protein and cytokines interleukin (IL)-1beta, IL-6, IL-8, and IL-10. Random 24-hour telephone diet recalls assessed energy intakes.
  
  
  RESULTS
  Weight loss began 1 week after CCR. Lean body mass (LBM) accounted for 71.7% +/- 21% of body mass loss. No change occurred in energy intakes or calorie/nitrogen ratio. REE was significantly increased when adjusted for LBM loss (kcal/kg), p = .019. LBM loss was significantly associated with physical performance decline, r = .71, p = .004, and increased functional dependence, r = .58, p = .02. Total physical activity level declined significantly, p = .003. Cytokine levels were strongly associated with physical and functional decline.
  
  
  CONCLUSIONS
  The aberrant changes in body composition, metabolism, and inflammatory state were associated with clinically and statistically significant impairments in physical performance and function. Future investigations and clinical practice should combine nutrition with antiinflammatory agents and exercise activities to support lean tissue anabolism and prevent physical and functional decline of patients with head and neck cancer undergoing CCR.
authors.affiliation: Department of Medicine, Vanderbilt Center for Human Nutrition, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. heidi.j.silver@vanderbilt.edu
authors.forename: Heidi J
authors.initials: HJ
authors.lastname: Silver
authors.forename: Mary S
authors.initials: MS
authors.lastname: Dietrich
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Murphy
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D001481:Basal Metabolism; D001823:Body Composition; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis; D016190:Carboplatin / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000532:radiotherapy*; D016207:Cytokines / Q000097:blood; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D007249:Inflammation / Q000097:blood; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D017239:Paclitaxel / Q000008:administration & dosage; D018714:Radiotherapy, Adjuvant
chemical_list: D016207:Cytokines; D002097:C-Reactive Protein; D016190:Carboplatin; D017239:Paclitaxel