Low Serum Albumin, Body Mass Index, and Feeding Route Predict Treatment Interruptions During Concurrent Chemoradiotherapy in Head and Neck Cancer: A Retrospective Cohort Study.

OBJECTIVE

To identify nutrition-related predictors of treatment interruption during concurrent chemoradiotherapy (CCRT), the primary outcome and to determine the secondary impact of interruption on 5-year overall survival (OS).

METHODS

This retrospective cohort study analyzed 440 head and neck cancer (HNC) patients receiving definitive CCRT (January 2013 to December 2016) at a tertiary academic center. Treatment interruption was defined as radiotherapy total treatment time > 56 days or cumulative delay > 7 days, and as chemotherapy delay > 7 days or premature discontinuation. Multivariable logistic regression identified independent predictors; Kaplan-Meier analysis compared 5-year OS by interruption status and tumor site.

RESULTS

Among 440 patients (mean age 55 years; 81.7% male), 52.3% experienced chemotherapy interruptions and 14.4% radiotherapy interruptions. Independent nutritional predictors of chemotherapy interruption were: serum albumin < 3.5 g/dL (adjusted OR 2.54, 95% CI 1.19-5.43, p = 0.016), pretreatment BMI category (overall p = 0.032, driven mainly by a protective trend for BMI > 25 kg/m2 [adjusted OR 0.55, 95% CI 0.30-1.00, p = 0.051]; the < 18.5 kg/m2 subgroup showed a nonsignificant increase in risk: adjusted OR 1.41, 95% CI 0.84-2.35, p = 0.196), and oral feeding (vs. feeding tube as reference) (adjusted OR 2.27, 95% CI 1.07-4.76, p = 0.030). In non-nasopharyngeal cancer, radiotherapy interruption significantly reduced 5-year OS (14.3% vs. 29.9%, p = 0.03). Chemotherapy interruptions did not significantly affect survival.

CONCLUSIONS

Hypoalbuminemia (< 3.5 g/dL), pretreatment BMI category, and feeding route independently predict chemotherapy interruptions in HNC. Radiotherapy interruptions significantly impair survival in non-nasopharyngeal cancers. These readily available markers should guide pretreatment nutritional optimization and feeding tube consideration in high-risk patients.