Systemic inflammation and prognostic markers in patients with head and neck cancer

• Patients with head and neck cancer (HNC) often present with weight loss and malnutrition caused by systemic inflammation and dysphagia. This thesis explores the effects of systemic and local inflammation in the context of head and neck cancer treatment. The main aim of Paper I was to investigate whether trismus after radiotherapy affects the 5-year overall survival rate in a cohort of 244 patients with HNC. The maximum interincisal opening (MIO) of the patients was measured before treatment, 2, 6, and 12 months after the termination of radiotherapy, and trismus was defined as MIO ≤ 35 mm. All patients received instructions on jaw-opening exercises. The highest prevalence of trismus at 12 months was seen in patients with oral cancer (44%) and oropharyngeal cancer (37%) and it can be concluded that these patients should primarily be offered jaw-opening exercises. Patients with trismus at 12 months after termination of treatment had a tendency towards a worse overall 5-year survival rate than patients without trismus (p=0.64).Paper II explored the expression levels of cytokines and growth factors in serum before and up to one year after treatment. The cohort consisted of 30 patients with HNC and blood was drawn on four occasions and analyzed for 10 cytokines and 4 growth factors. Patients who received chemoradiotherapy had higher expression levels of IL-1β, IL-6, and IL-10 than other treatment groups at 7 weeks after the start of treatment. Patients with recurrence within 12 months after termination of treatment had higher expression levels of IL-1β, IL-6, IL-8, and IL-10 than the remaining patients at 7 weeks.In Paper III the expression levels of 83 immuno-oncologically significant proteins were determined at the same four time points as in Paper II in a cohort of 180 patients with HNC using a proteomics technique. Fifteen proteins had either decreased or increased expression levels at 7 weeks compared to pre-treatment expression levels. Treatment with radiotherapy with concomitant cisplatin was shown to be connected to significantly decreased expression of 13 proteins at 7 weeks after the start of treatment compared to radiotherapy which demonstrates an immunomodulatory effect of cisplatin also apparent in Paper II.The aim of Paper IV was to investigate how pre-treatment body mass index and fat free mass index correlate with early death in a cohort of 404 patients with head and neck squamous cell carcinoma (HNSCC). Body mass composition was measured at diagnosis using bioelectrical impedance analysis. Patients who died within 6 months of the start of treatment had significantly lower FFMI at diagnosis compared with patients who survived beyond 6 months (17.6 kg/m2 and 19.5 kg/m2, respectively, p=0.035). It can be recommended that assessment of fat free mass index should be included in the management of patients with HNSCC prior to treatment.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Cancer och onkologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cancer and Oncology (hsv//eng)

Nyckelord

trismus

body mass composition

radiotherapy

cisplatin

proteomics

Publikations- och innehållstyp

vet (ämneskategori)

dok (ämneskategori)