Presented at the Triological Society Eastern Section Meeting, Philadelphia, Pennsylvania, U.S.A., January 25–27, 2008. Editor's Note: This Manuscript was accepted for publication February 21, 2008.
Effect of Body Mass Index on Chemoradiation Outcomes in Head and Neck Cancer†
Version of Record online: 2 JAN 2009
Copyright © 2008 The Triological Society
Volume 118, Issue 7, pages 1180–1185, July 2008
How to Cite
McRackan, T. R., Watkins, J. M., Herrin, A. E., Garrett-Mayer, E. M., Sharma, A. K., Day, T. A. and Gillespie, M. B. (2008), Effect of Body Mass Index on Chemoradiation Outcomes in Head and Neck Cancer. The Laryngoscope, 118: 1180–1185. doi: 10.1097/MLG.0b013e31816fca5c
- Issue online: 2 JAN 2009
- Version of Record online: 2 JAN 2009
- Head and neck neoplasms;
- body mass index;
- organ preservation;
- combined modality therapy;
Objective: To investigate the association between initial body mass index (BMI) and chemoradiation therapy (CRT) outcomes in head and neck cancer patients.
Methods: Retrospective study of 72 patients with American Joint Committee on Cancer stage III or IV squamous cell carcinoma of the oropharynx, hypopharynx, or larynx treated with primary concurrent CRT with curative intent over a 5 year period. Logistic and Cox regression analyses were used to determine the association between initial BMI and percutaneous endoscopic gastrostomy tube dependence, tumor recurrence, disease-free survival, and overall survival while controlling for the independent variables of age, sex, race, site, stage, and smoking and alcohol use.
Results: Patients with normal or low BMI (BMI ≤25 kg/m2) were significantly more likely to be percutaneous endoscopic gastrostomy dependent at last follow-up (odds ratio 4.13; 95% confidence interval [CI] 1.3–12.9; P = .014). This group also had significantly earlier recurrence (hazard ratio 4.4; 95% CI 1.2–15.9; P = .026) and shorter overall survival (hazard ratio 3.6; 95% CI 1.04–12.6, P = .043).
Conclusions: The present study suggests that CRT patients with BMI greater than 25 have improved swallowing outcomes, longer time to disease recurrence, and improved survival when compared with similar patients with lower BMI. BMI at presentation may be an important clinical factor to consider when determining the optimal treatment modality for a head and neck cancer patient. Further investigation is required to determine whether primary surgery should be the preferred treatment in normal or low BMI patients.