Nutritional Prognostic Index as Chemoradiotherapy Tolerance Marker

Chang et al. conducted a study to evaluate whether poor Immuno nutritional status - as assessed by the Nutritional Prognosis Index (NPI) - is associated with reduced tolerance to chemoradiotherapy (QRC) and increased side effects associated with it in cancer patients head and neck.

Patients in stages III, IVA or IVB of the disease were selected and were being treated with primary QRC, totalling 143 patients. Demographic data, a primary site of disease, stage of the tumour at diagnosis, nearby lymph nodes involved and presence of metastasis (assessed by Malignant Tumor Classification - TNM), exposure to smoking, weight before and after treatment, and parameters (serum albumin and total lymphocyte count). Treatment tolerance was assessed by the dose of chemo and radiotherapy used because the patient had completed the treatment and if the planned duration was fulfilled, sepsis, haematological toxicity (leukopenia, neutropenia, thrombocytopenia and anaemia), degree of mucositis/pharyngitis and occurrence of nausea and vomiting. The IPN was calculated from 10 x serum albumin (g / dL) + 0.005 x total lymphocyte count (n / mm³), and the patients were divided into low (n = 72) and high (n = 71) IPN.

Patients with low IPN had a tendency to have more advanced TNM and tumour stage (p = 0.092), and a lower tolerance to QRC, even when they received lower doses of chemotherapy (p = 0.018) and performed a shorter time of radiotherapy (p = 0.045). Weight loss was higher (p = 0.124) and the need for an enteral catheter was more common (p = 0.021) in the group with lower IPN. There was no difference between mucositis/pharyngitis degrees and nausea and vomiting between groups. Patients with low IPN had higher probabilities of toxicity (p = 0.044), sepsis (p = 0.029) and toxic death (p = 0.055). In the group with high IPN, one patient died of neutropenic sepsis, while in the group with low IPN, four patients died of neutropenic sepsis, one died of empyema and one died of tumour haemorrhage.

The authors concluded that there is a strong association between IPN and QRC-related toxicity. Therefore, patients with low IPN require a more careful multidisciplinary evaluation and support to ensure success and completion of their treatment and to avoid subsequent related toxicities.

Reference:

Chang PH et al. Prognostic nutritional index relevance in chemoradiotherapy for advanced oral cavity, oropharyngeal and hypopharyngeal cancer. Asia Pac J Clin Nutr. 2018;27(5):996-1001.