| Nutritional risk in head and neck cancer patients receiving radiotherapyPurposes To analyze the incidence rate of nutritional risk in head and neck cancer patients before and during radiotherapy and the relationship between nutritional risk and clinical outcomes.Methods Between January 2009 and April 2012,336 patients with head and neck cancer treated in our institution were retrospectively analyzed. Nutritional risk was defined by Nutritional Risk Screening 2002 (NRS2002). Logistic regression model was used to detect related factors to nutritional risk; Chi-square test was used to test the differences between groups; Kaplan-Meier method was used to estimate the treatment outcomes and Log-rank test was used to detect the impact of nutritional risk on patient’s outcome.Results The overall incidence of nutritional risk for head and neck cancer patients was 61.3% with a highest incidence rate(49.4%) during treatment. The incidence rate of nutritional risk before treatment related to tumor site (p= 0.030), clinical stage (p= 0.004), kps (p= 0.000), whereas the incidence rate of nutritional risk during treatment was higher in patients receiving concurrent chemo-radiotherapy. Patients who have nutritional risk before treatment tended to have worse prognosis (3y-OS 62.9%vs.81.2%, p= 0.007; 3y-LRC 84.9% vs.94.3%, p=0.042; 3y-DFS 64.8% vs.84.4%,p=0.006). There was no relevance between nutritional risk and treatment interruption and acute toxicities.Conclusions The incidence of nutritional risk is very high in head and neck cancer patients, especially during radiotherapy. NRS 2002 can predict patient’s prognosis before treatment.Nasopharyngeal carcinoma in children and adolescents-a single institution experience of 158 patientsObjective To evaluate the clinical features, treatment results, prognostic factors and late toxicities of nasopharyngeal carcinoma in children and adolescents.Methods Between January 1990 and January 2011,158 NPC patients younger than 20 years old were treated in our institution, and the patient’s clinical characteristics, treatment modalities, outcomes and prognostic factors were retrospectively analyzed.Results There were 9 (5.7%) patients in stage II,60 (38.0%) in stage III and 89 (56.3%) in stage IV according to the UICC2002 staging system. Neck mass (32.3%), headache (21.5%) and nasal obstruction (15.2%) were the most common chief complaints. With a median follow-up time of 62.5 months (range 2.0-225.0 months), the 5-year overall survival (OS) rate, local-regional control (LRC) rate and distant metastasis-free survival (DMFS) rate were 82.6%,94.9% and 76.4%, respectively. There were 43 (27.2%) patients failed during the follow up, with seven local-regional recurrences and 38 distant metastases. In univariate analysis, the 5-year OS of T4 and T1-3 were 75% and 87.9%, p= 0.01, stage IV and stage II-III were 77.1% and 90%, p= 0.04, respectively. In multivariate analysis, T4 (p=0.02) and stage IV (p= 0.04) were the independent adverse prognostic factors for OS. Significant reduction in trismus (27.3% v 3.6%, p= 0.03) and G2 xerostomia (37.9% v 10.3%, p=0.02) was observed in patients treated by IMRT.Conclusions Most childhood and adolescence nasopharyngeal carcinoma patients were locally advanced diseases at first diagnosed. The treatment results of radiotherapy, with or without chemotherapy, are excellent in our institution. Reducing distant metastasis with new strategies and late toxicities with intensity-modulated radiotherapy are the future directions for the treatment of adolescent nasopharyngeal carcinoma. |
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