title: Radiotherapy on the neck nodes predicts severe weight loss in patients with early stage laryngeal cancer.
abstract: OBJECTIVE
  Although patients with early stage (T1/T2) laryngeal cancer (LC) are thought to have a low incidence of malnutrition, severe weight loss is observed in a subgroup of these patients during radiotherapy (RT). The objective of this study was to evaluate weight loss and nutrition-related symptoms in patients with T1/T2 LC during RT and to select predictive factors for early identification of malnourished patients.
  
  
  METHODS
  Of all patients with T1/T2 LC, who received primary RT between 1999 and 2007, the following characteristics were recorded: sex, age, TNM classification, tumour location, radiation schedule, performance status, quality of life, weight loss, and nutrition-related symptoms. The association between baseline characteristics and malnutrition (>5% weight loss during RT) was investigated by Cox regression analysis.
  
  
  RESULTS
  The study population consisted of 238 patients. During RT, 44% of patients developed malnutrition. Tumour location, TNM classification, RT on the neck nodes, RT dose, nausea/vomiting, pain, swallowing, senses problems, trouble with social eating, dry mouth and the use of painkillers were all significantly associated with malnutrition. In the multivariate analysis, RTs on both the neck nodes (HR 4.16, 95% CI 2.62-6.60) and dry mouth (HR 1.72, 95% CI 1.14-2.60) remained predictive. Nevertheless, RT on the neck nodes alone resulted in the best predictive model for malnutrition scores.
  
  
  CONCLUSIONS
  Patients with early stage laryngeal cancer are at risk of malnutrition during radiotherapy. Radiotherapy on the neck nodes is the best predictor of malnutrition during radiotherapy. Therefore, we suggest to offer nutritional counselling to all the patients who receive nodal irradiation.
authors.affiliation: Department of Nutrition and Dietetics, VU University Medical Center, Amsterdam, The Netherlands.j.langius@vumc.nl
authors.forename: Jacqueline A E
authors.initials: JA
authors.lastname: Langius
authors.forename: Patricia
authors.initials: P
authors.lastname: Doornaert
authors.forename: Marieke D
authors.initials: MD
authors.lastname: Spreeuwenberg
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Langendijk
authors.forename: C René
authors.initials: CR
authors.lastname: Leemans
authors.forename: Marian A E
authors.initials: MA
authors.lastname: van Bokhorst-de van der Schueren
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D003680:Deglutition Disorders / Q000209:etiology; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008198:Lymph Nodes / Q000528:radiation effects*; D008207:Lymphatic Metastasis / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D011788:Quality of Life; D011879:Radiotherapy Dosage; D012307:Risk Factors; D013280:Stomatitis / Q000209:etiology; D011795:Surveys and Questionnaires; D015431:Weight Loss; D014987:Xerostomia / Q000209:etiology