Appraisal of Beneficial Effects of Oral Supplementation with Folic Acid during Curative Chemo-Radiation for Head and Neck Cancer: An Observational Study

Background: In people undergoing curative radiation treatment to the head and neck region the local effects like mucositis, dysphasia, dermatitis, salivary dysfunction and systemic effects like anaemia and leucopoenia are major issues. Folic acid is always provided when a patient has anaemia and is also regularly used in the care of cancer patients. However, literature study indicates that the quantum of beneficial effects of folic acid supplementing to patients undergoing curative radiotherapy are lacking. In lieu of these observations the present study was conducted to ascertain the beneficial effect of folic acid supplementation to head and neck cancer (HNC) patients undergoing curative radiotherapy. Methods: This was an observational study and was carried out in HNC patients planned for curative radiotherapy. The folic acid levels were estimated at the start of the study. Patients who had folic acid less than 20 ng/ml were prescribed folic acid (5 mg TID) for the first two weeks. The incidence of mucositis, dysphasia, dermatitis, salivary dysfunction, anaemia and leucopoenia were analysed at the end of the study. For analysis we studied what is the effect in people who had folic acid less than and, above 5 ng/ml and analysed the results using the X2 analysis. Results: The results indicated that there was a significant difference (p = 0.03) was seen in the incidence of leukopenia in the volunteers who had less than 5 ng/ml of folic acid. A significant difference in the incidence of severe dermatitis (P = 0.04) and in weight loss (P = 0.02) was also observed. Conclusions: The study findings suggest that when compared to the patients who had folic acid less than 5 ng/ml, administering folic acid was beneficial in mitigating dermatitis, weight loss and leucopenia in people with folic acid above 5 ng/ml. More studies are required to ascertain the benefit of folic acid.

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Evaluation of the prevalence and severity of xerophthalmia in head and neck cancers patients undergoing curative radiotherapy

Asian Journal of Ophthalmology ◽

10.35119/asjoo.v14i4.149 ◽

2016 ◽

Vol 14 (4) ◽

Author(s):

Sowmya V ◽

Dipika Jayachander ◽

Vijna Kamath ◽

Mithun SK Rao ◽

Mohammed Raees Tonse ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Keratoconjunctivitis Sicca ◽

Study Objective ◽

Cancer Group ◽

Curative Radiotherapy ◽

Significant Difference ◽

Rectal Cancers

Background: The study objective was to assess the development of xerophthalmia [dry eye syndrome (DES) or keratoconjunctivitis sicca] in head and neck cancer patients undergoing radiotherapy.Methods: Twenty two head and neck cancer patients requiring more than 60 Gy of curative radiotherapy/chemoradiotherapy and ten patients requiring radiotherapy/ chemoradiotherapy for treating cancers in the non head and neck regions (like breast, oesophagus, prostate, cervix and rectal cancers) were also enrolled in the study. The development of DES was studied at the beginning (day 0, before the start of radiotherapy) at day 21 (after completion of 30 Gy) and on completion of the treatment (> 60 Gy). As a comparative cohort, people with non head and neck cancer needing curative radiotherapy were also evaluated for comparison.Results: There was no difference in degree of DES between the Head and Neck cancer cohorts and non head and neck group at the beginning of treatment. However there was a statistically significant difference (p < 0.001) between the two groups at both mid and end of RT time point. Inter comparison between the various time points in the head and neck cancer group showed that the incidence of DES increased with the radiation exposure and was significant (pre to mid p < 0.001; and mid to end p < 0.005). A negative (r = -0.262) correlation was seen between DES and distance.Conclusions: The study showed that lesser the distance from the epicenter of the radiation to the orbital rim more was the severity of DES.

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The Association of Cachexia with Head and Neck Cancer Burden and Pathologic Features

Proceedings of IMPRS ◽

10.18060/24742 ◽

2020 ◽

Vol 3 ◽

Author(s):

Marelle Rukes ◽

Alexander Jones ◽

Leah Novinger ◽

Kyle Davis ◽

Vincent Campiti ◽

...

Keyword(s):

Weight Loss ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Head And Neck Carcinoma ◽

Depth Of Invasion ◽

Skeletal Muscle Index ◽

Pathologic Features ◽

Significant Difference ◽

The Impact

Background and Hypothesis: Head and neck cancer (HNC) is frequently associated with cachexia, characterized by involuntary weight loss, sarcopenia, and malnutrition. In HNC patients, dysphagia and anorexia from obstructive aerodigestive tumors propagates cachexia even further. However, the impact of pathologic features and burden of HNC on cachexia has yet to be investigated. We therefore hypothesize that larger, more aggressive tumors impose greater cachexia severity in HNC patients. Methods: A single-institution, retrospective study of adult patients undergoing surgical resection of head and neck carcinoma from 2014-2017 was performed. Patients without 30-day preoperative abdominal CT imaging for skeletal muscle index (SMI, cm2/m2) measurements were excluded. Patient demographics, comorbidities, nutrition data, and cancer pathology reports were collected. Cachexia was defined as unintentional weight loss >5% over 6 months or >2% with BMI <20 kg/m2. Statistical analyses were performed using 2-sided one-way Welch’s ANOVA or Pearson’s c2 tests. Significance was determined at p <0.05. Results: The cohort included 125 predominantly white (92.0%), male (75.2%) HNC patients age 59.9 ± 11.5 years. Sixty-seven (53.6%) patients had cachexia, twenty (16.0%) of whom were severe (weight loss ≥15%). Patients with severe cachexia had larger tumors (5.5 ± 2.1 cm, p=0.021) than patients with mild-to-moderate cachexia (weight loss 5-14.9%; 4.9 ± 2.1 cm) or no cachexia (4.1 ± 1.9 cm). Worsening cachexia severity was also associated with lower SMI (p=0.004), BMI (p=0.002), and serum albumin (p=0.011). There was no statistically significant difference between cachexia groups comparing patient age, comorbidities, tumor grade, depth of invasion, nodal metastases, cancer stage, perineural invasion, lymphovascular invasion, or extranodal extension. Conclusion and Potential Impact: Tumor burden of HNC patients, but not adverse pathologic features, is associated with greater cachexia severity. Identifying pro-cachectic markers produced by larger tumors could provide a molecular target for anti-cachexia therapies and improve cancer patient outcomes.

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