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• W2973038138 abstract "Growing evidence shows that inflammation and poor nutritional status in cancer patients are associated with morbidity and mortality. Serum markers include neutrophil to lymphocyte ratio (NLR) and albumin. Limited data has been presented in patients with head and neck cancer, especially on the significance of these measures in patients receiving external beam radiation therapy (EBRT) and concurrent chemoradiotherapy (CCRT). We reviewed our institutional experience of patients receiving CCRT and assessed outcomes with respect to albumin and NLR. Medical records of consecutive patients treated for histologically-proven head and neck cancer at a single center between 2011 and 2016 were reviewed. Patients received intensity-modulated radiotherapy and concurrent chemotherapy with or without induction. Standard dosing was 70 Gray (Gy) in the definitive setting and 60 Gy in the post-operative setting. Serum values were collected prior to commencement of any chemotherapy and radiation. The NLR ratio was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. Thresholds for pretreatment albumin and NLR were defined based on previously published criteria. Association between patient factors and outcomes were calculated in univariate and multivariate analyses. Two-hundred seventy-four patients met the criteria for inclusion in this study with a median follow-up time of 34 months (range, 1.5- 83 months). The population was mostly white (90%), and most received definitive therapy (78.5%). The most common subsite was oropharynx (64%), 135 (77%) of which were p16-positive. All patients received CCRT, including 22 patients receiving induction therapy. An NLR ≥ 3 occurred in 154 (56%) patients and 32 (12%) patients met criteria for hypoalbuminemia (≤ 3.5 g/dL). Thirty-seven percent of patients experienced chemotherapy delays of >1 week and 12% had radiation breaks of > 1 week. High NLRs were associated with chemotherapy toxicity and worse survival on univariate analyses but not on multivariate analyses. On multivariate analyses, smoking status was associated with chemotherapy toxicity (HR=2.09, p<0.01) while age (HR=3.42, p<0.01) and hypoalbuminemia (HR=0.34, p=0.02) were associated with prolonged radiation breaks. Hypoalbuminemia was independently associated with worse overall survival (HR=0.46, p<0.01) and progression free survival (HR=0.60, p=0.05). Pretreatment albumin has the potential to serve as a predictor for radiation treatment tolerance and predict poor oncologic outcomes in patients with head and neck cancer receiving CCRT. This evaluation may identify patients needing aggressive nutritional support and early symptom management as a component of their care." @default.
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• W2973038138 date "2019-09-01" @default.
• W2973038138 modified "2023-09-23" @default.
• W2973038138 title "Nutritional and Inflammatory Markers as Predictors for Chemoradiation Tolerance and Outcomes in Head and Neck Cancer" @default.
• W2973038138 doi "https://doi.org/10.1016/j.ijrobp.2019.06.1638" @default.
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