Nutrition in head and neck RT Evaluating predictive factors for determining enteral nutrition in patients receiving radical radiotherapy for head and neck cancer: A retrospective review Stephen Mangar * , Nicholas Slevin, Kathleen Mais, Andrew Sykes Department of Clinical Oncology, Christie Hospital NHS Trust, Manchester, UK Abstract Background and purpose: 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. Patients and 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 O20/day. The combination of these factors predicted a 75% chance of needing enteral nutrition. Conclusion: 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. q 2006 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 78 (2006) 152–158. Keywords: Head and neck cancer; Nutrition; Radiotherapy Malnourishment is common in the head and neck cancer patient affecting up to 40% of those at the time of diagnosis [1]. The effect of the cancer itself in terms of causing malnourishment—(cancer cachexia) is well recognised and caused by factors such as reduced absorption from the gastrointestinal tract, alteration in diet and reduced appetite, hormone induced metabolic changes and cancer immune activation with cytokine release [2]. The head and neck cancer patient presents additional problems in terms of nutritional deficits. The anatomical location of the tumour itself can cause problems with dysphagia, and deglutination, and thus physically restrict oral intake for a considerable period of time before presentation. These patients are also likely to come from a poor social environment where a reduced intake and quality of diet (i.e. lacking fresh fruit and vegetables) may lead to vitamin deficiencies. In addition, treatment itself with radiotherapy causes mucosal reactions that may further limit oral intake necessitating hospital admission and resulting in treatment interruptions, which can have an effect on overall outcome. The increasing use of chemo- radiotherapy treatment of head and neck cancer may increase the severity of mucosal reactions, as well as nausea and vomiting and thus contribute further the complexity of nutritional assessment in these patients [3]. It is well recognised that weight loss can be used as a surrogate for nutritional assessment [4], and weight loss associated with malignancy has substantial prognostic significance [5]. In particular for head and neck cancer, pre-treatment weight loss is an independent predictor of survival in those that have advanced stage disease. In a prospective study by Brookes [6], who analysed the nutritional status of 114 patients with newly diagnosed squamous cell carcinoma of the head and neck, 0167-8140/$ - see front matter q 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.radonc.2005.12.014 Radiotherapy and Oncology 78 (2006) 152–158 www.thegreenjournal.com