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Objective To explore the impact of oral nutritional supplements in the local advanced nasopharyngeal carcinoma patients receiving chemoradiotherapy. Methods From 2016 to 2018, we prospectively collected 114 patients into our study, including intervention group ( n=58) and control group ( n=56) . Patients in the intervention group were given oral nutritional supplements from the beginning of radiotherapy, while the control group patients were receiving usual diet care. We collected data of weight, hematological index and nutrition related information before, during and after treatments. Results All patients experienced weight loss during radiotherapy. The declining trend was more obvious in intervention group but with no statistical difference ( P>0.05) . Radiotherapy interruption was lower, completion rate of 2 cycles of concurrent chemotherapy was higher( 78% vs 64%, P=0.02) and level of total serum protein and albumin was more stable ( P=0.003, 0.001) in the intervention group. No difference was found in acute toxicities between the two groups ( P>0.05) . During the treatment period, the nutrition risk screening score declined, more patients with NRS 2002 ≥3 in the control group than the intervention group ( P<0.05) , while no statistically significant difference was found in PG-SGA between the two groups ( P>0.05 ) . Conclusions Oral nutritional supplements can improve treatment tolerance and keep the stability of serum protein level, nevertheless, it has no obvious advantage in maintenance of weight and short-term nutritional status
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Objective To prospectively determine the dosimetric and clinical factors for predicting the risk of acute radiation oral mucositis ( ROM ) in patients receiving intensity?modulated radiotherapy ( IMRT) with concurrent chemotherapy for local advanced nasopharyngeal carcinoma. Methods Ninety?two patients who were treated with IMRT with concurrent chemotherapy from 2015 to 2016 for local advanced nasopharyngeal carcinoma were included in this study, and their acute ROM was scored according to the RTOG criteria. Grade≥3 ROM was used as a surrogate marker for severe mucositis, which was defined as a toxicity endpoint. The clinical data were reviewed, and the dose?volume histograms ( DVHs) of the patients were exported from the IMRT planning system. Optimal thresholds for predicting the incidence of severe ROM were evaluated by the area under the receiver operating characteristic ( ROC) curve ( AUC) . Results The incidence of severe ROM was 21%(19/92). Weight loss and V30 of the oral mucosa were determined as the independent predictors for severe ROM ( P=0017 and 0003, respectively) . The optimal cut?off point and AUC of V30 of the oral mucosa as a predictor for severe ROM were 7316%( 0842 sensitivity and 0671 specificity) and 0753( P=0001) , respectively. Conclusion Weight loss and V30 of the oral mucosa are predictors for severe ROM.
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Objective To investigate the relationship between nutritional status and quality of life ( QOL) in patients with nasopharyngeal carcinoma undergoing concurrent chemoradiotherapy, and to identify the optimal indices of body composition for evaluation of malnutrition. Methods Based on the European Society Parenteral and Enteral Nutrition ( ESPEN) consensus on the diagnosis of malnutrition and patient?generated subjective global assessment (PG?SGA), a prospective study was performed in 48 patients with nasopharyngeal carcinoma who received concurrent chemoradiotherapy in our hospital from 2014 to 2015. Changes in body composition and nutritional status were evaluated in those patients. The relationship between nutritional status and QOL was studied. The predictive factors for nutritional status in patients with nasopharyngeal carcinoma were explored. The correlation between datasets was evaluated by the Pearson correlation coefficient. The influencing factors for nutritional status were analyzed by Logistic regression. Results During concurrent chemoradiotherapy, some indices of body composition, including weight, body mass index ( BMI) , fat mass index ( FMI) , fat?free mass index ( FFMI) , body cell mass ( BCM) , skeletal muscle mass ( SM) , and phase angle ( PA) had different degrees of reduction ( P=0?00) , while the PG?SGA score gradually increased. The incidence of malnutrition in patients with nasopharyngeal carcinoma during radiotherapy was 2?1%?39?6% based on 2015 ESPEN consensus on the diagnosis of malnutrition and 12?5%?41?7% based on PG?SGA. These two methods showed good agreement at the fourth and sixth weeks of radiotherapy ( Kappa=0?911;Kappa=0?957) . The changes in QOL score were correlated with changes in FFMI and weight during radiotherapy ( r= 0?805, P= 0?00;r= 0?777, P= 0?00 ) . Logistic regression indicated that age, FMI, and FFMI were influencing factors for nutritional status ( P= 0?035, 0?013, 0?043) . Conclusions Patients with nasopharyngeal carcinoma have substantial nutritional deterioration during chemoradiotherapy. The nutritional status is closely associated with QOL. A prediction model of nutritional status can provide a comprehensive and accurate judgment of nutritional status in patients.
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Objective To investigate the efficacy and side effect of induction chemotherapy plus concurrent chemoradiotherapy ( IMRT) in the treatment of 81 patients with locally advanced nasopharyngeal carcinoma ( NPC) . Methods 81 patients with locally advanced NPC were divided into the vinorelbine group and fluorouracil group . Patients in the vinorelbine group were given vinorelbine 25-30mg/m2 d1,d8,DDP 75mg/m2 ,d1-d3.Patients in the fluorouracil group were given DDP 75mg/m2,d1-d3,fluorouracil 750 mg/m2 d1-d5.The treatment schedules were recycled every 3 weeks.After 2-4 cycles, the patients received concurrent chemoradiotherapy .In the vinorelbine group,IMRT with NVB 25-30mg/m2,DDP 40mg d1,d8,d22,d29,d43,d51 from the first day of IMRT.In the fluorou-racil group,IMRT with fluorouracil 750mg/m2 ,DDP 25/m2 d1,d8,d22,d29,d43,d51 from the first day of IMRT. Results The overall leukopenia and thrombocytopenia decline was 47.5% vs 24.4% in patients with Ⅲ and Ⅳgrade(χ2 =4.73,P<0.05).5-year locoregional relapse-free survival rates were 85.0% vs 65.9%(χ2 =4.05,P<0.05).5-year overall survival rates were 85.0%vs 68.3%(χ2 =3.18,P<0.05).Conclusion NP regiment induc-tion chemotherapy plus concurrent chemoradiotherapy for advanced NPC can achieve better result in clinical response and 5-year locoregional relapse-free survival rate compared with FP and the effect is clinically acceptable .
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Objective To evaluate the impact of chemotherapy compliance on the therapeutic efficacy of induction chemotherapy plus concurrent chemoradiotherapy versus induction chemotherapy plus radiotherapy alone for patients with locally advanced nasopharyngeal carcinoma (NPC). Methods Based on intention to treat analysis (ITT) for 400 patients, 314 patients were analyzed by per protocol (PP) analysis. The patients were divided into induction chemotherapy plus concurrent chemoradiotherapy group (IC/CCRT, 127 patients) or induction chemotherapy plus radiotherapy group (IC/RT, 187 patients). The patients who completed 2 cycles of induction chemotherapy and at least 2 cycles of concurrent chemotherapy in the IC/CCRT group and the patients who completed 2 cycles of induction chemotherapy in the IC/RT group were analyzed. Radiotherapy was given by two-dimensional technique with γ-ray, X-ray and electron beams. The chemotherapy regimen was FUDR plus carboplatin for induction chemotherapy and carboplatin alone for concurrent chemotherapy. Results The follow-up rate was 96.2%. 295 patients were followed to at 3 years. Based on PP analysis, Grade 3/4 toxicity was found in 23.6% of the patients in IC/CCRT group and 13.4% in the IC/RT group (χ~2 =5,50,P=0.019). No grade 4 toxicity was found in the IC/RT group. The median follow-up time was 3.9 years, and no significant difference was found between the two groups in 3-year overall survival (78.1% : 84.6% ;χ~2 = 0. 61, P =0. 435), disease-free survival (74.3 % : 70.1% ;χ~2= 0. 12, P= 0.731), Iocoregional relapse-free survival (89.7% : 89.5% ; χ~2= 0. 10, P= 0.748), or distant metastasis-free survival (78.9%:76.5% ;χ~2=0.05,P=0.825). Conclusions With more severe toxicities, the IC/CCRT regimen does not improve the overall survival in locally advanced NPC patients compared with the IC/RT regimen.