Weight Loss in Nasopharyngeal Cancer is Mainly Associated with Pre-Treatment Dental Extraction, a European Single-Center Experience

S. Benkhaled, T. Dragan, S. Beauvois, A. D. Caluwé, D. V. Gestel
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Abstract

Background: The treatment of nasopharyngeal carcinoma (NPC) consists of radiotherapy alone (stage I) or radiotherapy concomitant with chemotherapy (stage II-V). Acute side effects management forms a major challenge for practitioners. Substantial literature is available from endemic areas, whereas data from Europe is scarce. This study examines clinical characteristics, therapeutic results, acute and late side effects of patients treated at the Jules Bordet Institute. Materials and Methods: Twenty-two consecutive non-metastatic NPC patients treated between May 2012 and September 2015 were retrospectively analyzed. All patients were treated by Intensity Modulated Radiation Therapy (IMRT) with or without chemotherapy (CT). Results: Thirteen patients have North-African ancestry while nine are of European origin. Seventy-three percent had a non-keratinizing carcinoma and 90% had an advanced stage disease (III-IVb). Ninety-five percent of the patients received concomitant CT. After a median follow-up time of 31 months, overall survival was 77%. Local, regional and distant control rates were 95%, 86% and 73%. Main acute grade 3 toxicities were swallowing disorders (91%), vomiting (82%), oropharyngeal mucositis (64%) and dermatitis (23%). Only one patient developed grade 4 dermatitis, requiring treatment discontinuation in the sixth week. In the seventh week of treatment, 86% of the patients had lost more than 10% of their starting weight. Univariate analysis identified three factors driving the weight loss: grade 3 mucositis of the soft palate (p=0.027), vomiting (p=0.019) and pre-treatment dental extraction (p=0.006). In multivariate analysis, weight loss is only linked to dental extraction (p=0.042, Odds Ratio 1.62, [95% CI: 1.16-2.80]). Late toxicities were xerostomia (68%), auditory symptoms (55%), hypothyroidism (45%) and swallowing disorders (23%). Conclusion: Our clinical characteristics outcome and toxicity are comparable to published data from endemic regions. Interestingly, weight loss of >10% is correlated to pre-treatment dental extraction. This finding should be confirmed and analyzed in a prospective manner.
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鼻咽癌患者体重减轻主要与治疗前拔牙有关,一项欧洲单中心研究
背景:鼻咽癌(NPC)的治疗包括单独放疗(I期)或放疗合并化疗(II-V期)。急性副作用的管理是从业者面临的主要挑战。来自流行地区的大量文献可获得,而来自欧洲的数据很少。本研究考察了在朱尔斯博德研究所接受治疗的患者的临床特征、治疗结果、急性和晚期副作用。材料与方法:回顾性分析2012年5月至2015年9月22例连续治疗的非转移性鼻咽癌患者。所有患者均接受调强放射治疗(IMRT),伴或不伴化疗(CT)。结果:13例患者有北非血统,9例有欧洲血统。73%的人患有非角化癌,90%的人患有晚期疾病(III-IVb)。95%的患者接受了CT检查。中位随访31个月后,总生存率为77%。局部、区域和远程控制率分别为95%、86%和73%。主要的急性3级毒性是吞咽障碍(91%)、呕吐(82%)、口咽粘膜炎(64%)和皮炎(23%)。只有1例患者出现4级皮炎,需要在第6周停止治疗。在治疗的第七周,86%的患者减轻了超过10%的体重。单因素分析确定了导致体重减轻的三个因素:软腭3级黏膜炎(p=0.027)、呕吐(p=0.019)和治疗前拔牙(p=0.006)。在多变量分析中,体重减轻仅与拔牙有关(p=0.042,优势比1.62,[95% CI: 1.16-2.80])。晚期毒性为口干症(68%)、听觉症状(55%)、甲状腺功能减退(45%)和吞咽障碍(23%)。结论:我们的临床特征、结局和毒性与流行地区发表的数据相当。有趣的是,体重下降10%与治疗前拔牙有关。这一发现应该以一种前瞻性的方式加以证实和分析。
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