Effect of body mass index on chemoradiation outcomes in head and neck cancer.
OBJECTIVE
To investigate the association between initial body mass index (BMI) and chemoradiation therapy (CRT) outcomes in head and neck cancer patients.


METHODS
Retrospective study of 72 patients with American Joint Committee on Cancer stage III or IV squamous cell carcinoma of the oropharynx, hypopharynx, or larynx treated with primary concurrent CRT with curative intent over a 5 year period. Logistic and Cox regression analyses were used to determine the association between initial BMI and percutaneous endoscopic gastrostomy tube dependence, tumor recurrence, disease-free survival, and overall survival while controlling for the independent variables of age, sex, race, site, stage, and smoking and alcohol use.


RESULTS
Patients with normal or low BMI (BMI < or =25 kg/m) were significantly more likely to be percutaneous endoscopic gastrostomy dependent at last follow-up (odds ratio 4.13; 95% confidence interval [CI] 1.3-12.9; P = .014). This group also had significantly earlier recurrence (hazard ratio 4.4; 95% CI 1.2-15.9; P = .026) and shorter overall survival (hazard ratio 3.6; 95% CI 1.04-12.6, P = .043).


CONCLUSIONS
The present study suggests that CRT patients with BMI greater than 25 have improved swallowing outcomes, longer time to disease recurrence, and improved survival when compared with similar patients with lower BMI. BMI at presentation may be an important clinical factor to consider when determining the optimal treatment modality for a head and neck cancer patient. Further investigation is required to determine whether primary surgery should be the preferred treatment in normal or low BMI patients.
McRackan
Theodore R
TR
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina 29725, USA.
Watkins
John M
JM
Herrin
Amy E
AE
Garrett-Mayer
Elizabeth M
EM
Sharma
Anand K
AK
Day
Terry A
TA
Gillespie
M Boyd
MB
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D015992:Body Mass Index; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D004750:Enteral Nutrition / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000706:statistics & numerical data; D006801:Humans; D007822:Laryngeal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000401:mortality; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D011379:Prognosis; D016016:Proportional Hazards Models; D020266:Radiotherapy, Conformal; D013223:Statistics as Topic; D015996:Survival Rate
D016190:Carboplatin; D002945:Cisplatin