Malnutrition is a frequent problem in patients with head and neck cancer. Prevention or timely treatment of malnutrition isof great importance because deteriorated nutritional status can have a negative effect on clinical outcome in head andneck cancer patients.Malnutrition is a multidimensional problem, in which a nutritional disbalance causes loss of weight and muscle mass, eitheror not accompanied by inflammatory activity, resulting in functional decline.Thus far, little is known about the role of physical activity in both the development and treatment of malnutrition in cancerpatients. Although positive effects of exercise on fatigue and quality of life have been reported, the relationship betweenphysical activity and prevention and treatment of malnutrition needs to be further elucidated.In this presentation, current insights and hypotheses on the relationship between physical activity and nutritional status inpatients with cancer will be discussed.
Purpose: This systematic review aimed to provide a comprehensive overview of the validity and reliability of existing measurement instruments for quantifying head and neck lymphedema. Methods: Four databases were searched on January 31st, 2022. The COnsensus-based Standards for selecting health Measurement INstruments (COSMIN) checklists were used for the risk of bias (ROB) assessment. Results: Out of 3362 unique records, eight studies examined the reliability and validity of five measurement instruments of which one patient reported outcome. The Patterson scale for internal lymphedema and the patient reported head and neck external lymphedema and fibrosis (LIDS-H&N) demonstrated validity and reliability. For external lymphedema, none of the instruments had good reliability for all measuring points. Conclusion: There is a lack of sufficiently reliable and valid measurement instruments for external head and neck lymphedema. The Patterson scale and the patient reported LIDS-H&N seem reliable for clinical practice and research.
Purpose / objective: Head and neck cancer patients treated with chemoradiation are at risk for developing trismus (reduced mouth opening). Trismus is often a persisting side-effect and difficult to manage. It impairs eating, speech and oral hygiene, affecting quality of life. Although several studies identified the masseter muscle (MM) as one of the main organs at risk, currently this structure is rarely considered during treatment planning. Prospective studies for chemoradiation are lacking. The aim of our study was to quantify the relationship between radiation dose to the MM and development of radiation-induced trismus in an IMRT-VMAT population. Results: At the first evaluation, 6-12 weeks post-treatment, fourteen patients had developed radiation-induced trismus (15%). On average, mouth opening decreased with 4.1 mm, or 8.2 % relative to baseline. Mean dose to the ipsilateral MM was a stronger predictor for trismus than mean dose to the contralateral MM, as indicated by the lowest -2 log likelihood (Table 1). Figure 1A shows the correlation between the ipsilateral mean masseter dose and the relative decrease in mouth opening, with trismus cases indicated in red. No trismus cases were observed in 33 patients (35%) with a mean dose to the ipsilateral MM < 20 Gy. The risk of trismus in the other 60 patients (65%) increased with higher mean doses to the ipsilateral MM. Figure 1B shows the fitted NTCP curve as a function of the mean dose, with a TD50 of 55 Gy. The actual incidence (with 1 SE) of trismus cases within 5 dose bins is indicated as well, showing a good correspondence with the NTCP fit with a relatively large uncertainty in the dose area > 50 Gy. Patients with tumors located in the oropharynx were at highest risk.
Relatie tussen spiermassa en vroegtijdig stoppen van chemotherapie bij patienten met hoofd-halskankerIn this study, we aim to assess whether low pre-treatment muscle mass, measured with CT at thoracic (T4) or lumbar level (L3) is associated with early termination of chemotherapy related to toxicity in head and neck cancer (HNC) patients.
In dit onderzoek wordt de uitvoerbaarheid van een bewegingsprogramma tijdens chemoradiatie bij patienten met hoofd-halskanker onderzocht.The feasibility of an exercise intervention during CRT in HNSCC patients will be studied to design an optimal, large-scale RCT comparing the exercise intervention during CRT to usual care (UC) with the aim of a beneficial effect on the tolerability of CRT and physical fitness, body composition, fatigue and QoL on the longer term.
