title: Effect on long-term survival of psychiatric disorder, inflammation, malnutrition, and radiotherapy-related toxicity in patients with locally advanced head and neck cancer.
abstract: OBJECTIVE
  To evaluate the effects on the long-term survival of psychiatric disorders, inflammation, malnutrition, and radiotherapy (RT)-related toxicity in patients with locally advanced head and neck cancer.
  
  
  METHODS
  Included were 47 patients who received RT for non-metastatic locally advanced head and neck cancer. The diagnosis of psychiatric disorder was made by the Diagnostic and Statistical Manual of Mental disorders (4th edn) (DSM-IV) criteria. Malnutrition was defined as weight loss >5% of baseline during RT. Interleukin 1β (IL-1β), IL-6, and tumor necrosis factor-alpha (TNF-α) were analyzed by enzyme-linked immunosorbent assay (ELISA). RT-related acute toxicity was evaluated once a week using the National Cancer Institute Common Toxicity Criteria (NCI-CTC) version 2.0.
  
  
  RESULTS
  The mean patient age was 57.3±11.4 years (range 33-80); 42 (89.4%) patients were male. Mean disease-free (DFS) and overall survival (OS) were 53 and 55 months, respectively. Mean DFS was significantly lower in patients with psychiatric disorder compared with those without (35 vs 59 months, p=0.013) and the same applied for mean OS (41 vs 61 months, p=0.008). There was no significant difference between patients with and without malnutrition in terms of OS. Similarly, no significant difference was seen between patients with and without RT-related toxicities in terms of OS. Age, psychiatric disorder, T status, and stage differed significantly between these groups (p<0.10) in univariate analysis. The multivariate Cox regression analysis identified that the OS was significantly associated only with psychiatric disorder (odds ratio/OR: 3.22, 95% confidence interval/CI: 1.29-8.41, p=0.013).
  
  
  CONCLUSIONS
  Psychiatric disorders had unfavorable effects on OS in patients with locally advanced head and neck cancer. Inflammation, malnutrition and RT-related toxicity had no significant impact on OS.
authors.affiliation: Department of Radiation Oncology, Kayseri Education and Research Hospital, Kayseri, Turkey.
authors.forename: Dilek
authors.initials: D
authors.lastname: Unal
authors.forename: Celalettin
authors.initials: C
authors.lastname: Eroglu
authors.forename: Saliha Demirel
authors.initials: SD
authors.lastname: Ozsoy
authors.forename: Asli
authors.initials: A
authors.lastname: Besirli
authors.forename: Okan
authors.initials: O
authors.lastname: Orhan
authors.forename: Bunyamin
authors.initials: B
authors.lastname: Kaplan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016371:Cranial Irradiation / Q000009:adverse effects* / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D018836:Inflammation Mediators / Q000097:blood; D053583:Interleukin-1beta / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D001523:Mental Disorders / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000523:psychology; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015995:Prevalence; D016016:Proportional Hazards Models; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D015431:Weight Loss
chemical_list: C508585:IL1B protein, human; C508600:IL6 protein, human; D018836:Inflammation Mediators; D053583:Interleukin-1beta; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha