Nutritional parameters for patients with head and neck cancer.

AIM: Determination of the optimal nutritional parameter to provide useful information for the individual patient and assessing the impact of nutritional status have on the prognosis of head and neck cancer. PATIENTS AND METHODS: Firstly a retrospective study analysed the outcome of 110 patients in relation to initial weight loss and weight loss at the end of radiotherapy. A second study investigated the changing bioimpedance (BIA) data of 27 survivors and 39 patients who died between their first and last measurement during nutritional therapy (at least four weeks). RESULTS: A critical initial weight loss is 10 kg or more at the point of diagnosis. At the end of radiotherapy the body mass reduction should be less than 15 kg. Raw data of BIA reflect the changing nutritional status at the end of life. We observed a stabilized phase angle in survivors (4.7° to 5.2°) whereas patients who died exhibited a significant lower phase angle (4.6° to 3.7°, p<0.05). CONCLUSION: The prognosis of head and neck cancer patients is highly related to their nutritional status. Specific nutritional anamnesis (initial weight loss, total weight loss, body mass index) and additional biophysical measurements such as BIA are recommended to monitor the individual status during the follow-up.

Definition of the CTV prostate in CT and MRI by using CT-MRI image fusion in IMRT planning for prostate cancer.

PURPOSE: To determine the prostate volumes defined by using MRI and CT scans, as well as the difference between prostate delineation in MRI and CT in three dimensions (3D). A further goal was to use MRI to identify subgroups of patients in whom seminal vesicle irradiation can be avoided. METHODS AND MATERIALS: A total of 294 patients with biopsy-proven prostate cancer (MRI stages: T(1), 16 [5%]; T(2), 84 [29%]; T(3), 191 [65%]; T(4), 3 [1%]) underwent pelvic CT and MRI scans before intensity-modulated radiation therapy (IMRT) planning. 3D images were used to compare the prostate volumes defined by superimposed MR and CT images. Prostate volumes were calculated in cm(3). RESULTS: The mean prostate volume defined by MRI (44.3 cm(3) [range, 8.8-182.8 cm(3)]) was 35% smaller than that defined by CT (68.5 cm(3) [range, 15.2-241.3 cm(3)]). The areas of nonagreement were observed predominantly in the most superior and inferior portions of the prostate. The incidence of seminal vesicle invasion (SVI) identified by MRI was 63% (n = 182 of 290). The median length of SVI was 2.6 cm (range, 1.1-4.7 cm; 62% of the median SV length). The low-risk patients (59%, n = 171 of 290) calculated by applying the Roach and Diaz formula had a SVI rate of 57% (n = 97 of 171), the high-risk patients (41%, n = 119 of 290) of 71% (n = 85 of 119). CONCLUSIONS: Compared with MRI, CT scans overestimate prostate volume by 35%. CT-MRI image fusion-based treatment planning allows more accurate prediction of the correct staging and more precise target volume identification in prostate cancer patients.