ORIGINAL ARTICLE
Evaluation of patients with head and neck cancer performing standard treatment in
relation to body composition, resting metabolic rate, and inflammatory cytokines
Thalyta Morandi Ridolfi de Carvalho, MD,1 Daniela Miguel Marin, PhD,1 Conceic~ao Aparecida da Silva, MD,1 Aglecio
Luiz de Souza, MD,1 Maristela Talamoni,2 Carmen Silvia Passos Lima, MD, PhD,1 Sarah Monte Alegre, MD, PhD1*
1 2
Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, S~ao Paulo, Brazil, Nutrition Service, University of Campinas, S~ao Paulo, Brazil.
Accepted 9 December 2013
Published online 25 April 2014 in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/hed.23568
ABSTRACT: Background. Squamous cell carcinoma of the
head and neck (SCCHN) usually emerges as a set of signs and
symptoms that, either alone or in combination with standard
treatment, may lead to mal-nutrition and weight loss.
Methods. This study evaluated patients with SCCHN before day 0
and 30 days after the end of treatment, with/without tumor
resection. Each indi-vidual patient underwent analyses of body
composition and resting met-abolic rate, as well as assessment of
serum glucose, insulin, leptin, adiponectin, interleukin-6 (IL-6),
tumor necrosis factor-alpha (TNF-a), IL-1b, and insulin sensitivity.
INTRODUCTION
Squamous cell carcinoma of the head and neck (SCCHN)
represents a serious health problem worldwide. The esti-
mated number of new cases of 1the tumor diagnosed per
year in the world is 780,000, 2and 48,000 cases are
expected only in the United States. In addition, 3the tumor
is related to 350,000 deaths per year in the world.
SCCHN usually emerges as a set of signs and symp-
toms, including lesions of the oral cavity, swelling of the
neck, difficulty in swallowing food, hoarseness, and
bleeding. These signals and symptoms can cause dyspha-
gia, odynophagia, trismus, anorexia, and taste changes,
resulting in decreased food intake, poor eating habits, and
4,5
high consumption of alcohol and tobacco. Usually, 30%
to 90% of patients with advanced-stage SCCHN are
affected by malnutrition,
6,7
which is an independent predic-
tor of mortality.
The standard adjuvant or palliative treatment for patients
with SCCHN consists of radiotherapy associated with high-
5,8
dose intravenous cisplatin. The treatment leads to
8
increased patient survival, but with unequivocal toxicity.
Side effects of the treatment include gastrointes-tinal
discomfort, xerostomia, mucositis, candidiasis,
*Corresponding author: S. Monte Alegre, Department of Internal Medicine,
Faculty of Medical Sciences, University of Campinas, Rua Alexandre
Fleming no 40, FCM 09, Bar~ao Geraldo, Campinas, S~ao Paulo, Brazil,
CEP: 13083-887. E-mail: salegre@fcm.unicamp.br
Results. There was body mass loss during treatment and
significant reduction in body fat and free fat mass. Early
nutritional monitoring and tumor resection before treatment led
to a better nutritional status and reduced inflammatory state.
Conclusion. Early nutritional monitoring and resection of the tumor by
surgery may be important factors for patients to better tolerate treat-
ment. VC 2014 Wiley Periodicals, Inc. Head Neck 37: 97102, 2015
KEY WORDS: cancer, head and neck, metabolism,
cachexia, indirect calorimetry
changes in taste ability, and osteoradionecrosis,
9 which may
cause or contribute to malnutrition.
10
In addition, Cao et al demonstrated that the type, stage,
and duration of cancer are conditions that induce altera-
tions in body weight and composition, and in resting meta-
bolic rate (RMR), which may lead to cachexia. Tumor
growth was also associated with the development of ano-
rexia, weight loss because of muscle and fat catabolism,
11
and increased energy expenditure. The most common
abnormalities in laboratorial parameters in cancer cachexia
are anemia, hypoalbuminemia, hypoglycemia,
lactacidemia, hyperlipidemia, and glucose intolerance.
12
Only a few studies have focused on the assessment of the
caloric needs of patients with SCCHN. In general, the
RMR of patients with cancer is consistently higher than the
13
RMR of healthy individuals. Indirect calorimetry was
described as a noninvasive method that determines the
nutritional needs and the rate of utilization of energy
substrates, according to the consumption of oxygen and
14
carbon dioxide production, and a detailed RMR evalua-
15
tion was postulated by Gibney as a necessary procedure
to provide suitable nutritional support to recover an inad-
equate nutritional status.
Moreover, inflammatory cytokines, produced by the
tumor itself, trigger a chronic inflammatory response that
also contributes to anorexia and weight loss, culminating in
16
anorexia-cachexia syndrome. Interleukin-6 (IL-6) is a
common mediator involved in the process of cachexia in
17
patients with cancer. Ryden et al found high serum IL-6
levels in patients with cachectic cancer with clear signs of
18
catabolism, whereas Iwase et al reported that IL-6
HEAD & NECKDOI 10.1002/HED JANUARY 2015 97
CARVALHO ET AL.
was involved in decreased survival of patients with cancer.
The purposes of this study were to examine the in-
volvement of antitumor treatment, including surgical
resection and/or chemoradiotherapy (CRT), in the nutri-
tional and metabolic status of patients with SCCHN.
MATERIALS AND METHODS
Patients
Thirty-two consecutive out-patients, aged 30 to 65 years
old, 31 men and 1 woman, with a confirmed diag-nosis of
SCCHN of stages III or IV (American Joint Can-cer
Committee criteria), and treated with CRT at the Oncology
Service of the Faculty of Medical Sciences of the State
University of Campinas, were included in study. Renal,
respiratory, heart and liver failure, abnormal bone marrow,
psychiatric disorders, systemic infection, meta-static
disease, nasopharynx tumor, poor clinical condition
(Karnofsky performance status index <70%), and the use of
anticonvulsant or previous antitumor therapy were con-
sidered as exclusion criteria for patients.
Patients received CRT (35 sessions of radiation, 2 Gy per
session, plus intravenous cisplatin at a dose of 75 100
2 oncology,
mg/m on days D1, D22, and D43), as previously
8 symptoms, alterations in dietary intake, and functional
reported. CRT was the unique treatment administered to
20 patients, in which surgical treatment was not per-formed
because of locoregional irresistibility (n 5 6), heart
ischemia (n 5 3), and refusal of surgery facing expected
functional or anatomic sequels (n 5 11). Twelve patients
received CRT 70 to 80 days after surgical tumor resection.
All patients were assessed 10 to 20 days before the
beginning of CRT and reassessed 30 to 40 days after fin-
ishing CRT. An interval of 60 days was required between
tumor resection and the first assessment in pertinent cases
to avoid contamination of biomarkers by inflammatory
changes associated with surgical procedure.
Nutritional (dietary pattern, nutritional status, and body
composition, Patient Generated Subjective Global Assess-
ment [PG-SGA]) and metabolic (RMR, glucose, insulin,
leptin, adiponectin, homeostasis model of assessment-
insulin resistance [HOMA-IR], IL-6, tumor necrosis factor-
alpha (TNF-a), IL-1b) biomarkers were analyzed in the
study.
Data collection started in January 2010 and finished in
July 2011.
Dietary assessment
A 24-hour dietary recall was performed by the principal
researcher before the beginning of CRT and after the end of
CRT, with the purpose of identifying the dietetic pat-tern
and to include information regarding energy, carbo-
hydrates, and fat and protein consumption. Moreover, fiber,
total cholesterol, and saturated fat were calculated by
NutWin, version 1.5 (Unifesp, S~ao Paulo, Brazil). The
software also quantified macronutrients and micronu-trients
ingested by the patients. Patients were followed up
individually and, when necessary, oral or enteral nutri-
tional supplementation was recommended. Only 2 patients
received enteral supplementation; the remaining patients
98 HEAD & NECKDOI 10.1002/HED JANUARY 2015
received oral supplements provided by the hospitals own
welfare clinic or through donations.
Evaluation of nutritional status and body composition
Body weight and height were measured for the body
mass index (BMI) calculation, and each patient was clas-
sified as underweight
19
(III, II, or I), eutrophic, overweight,
or obese (I or II).
A tape was used to measure the midarm circumference
(MC). The triceps skin fold (TSF) thickness was meas-ured
in millimeters using a Lange skinfold caliper. All
measurements were made on the right side, with the patient
standing. The muscular midarm circumference (MMC) was
calculated as follows: MMC (cm) 5 MC - p 3 TSF
thickness.
Body composition was measured by bipolar bioelectri-
cal impedance analysis (BIA 310; Biodynamics, Seattle,
20
WA), as described ; the analyses were carried out with the
patients under fasting conditions laying awake for 30
minutes with their arms at their sides without touching the
body.
Patient Generated Subjective Global Assessment
PG-SGA,21,22
a specific nutritional evaluation tool for
was evaluated in the study to address: (1)
percentage of weight loss in the previous 6 months,
capacity; (2) parts of metabolic stress; and (3) physical
examination. At the end of the evaluation, through a com-
bination of subjective parameters, each patient was classi-
fied as well nourished (score A), mildly/moderately
malnourished (score B), or severely malnourished (score
C), as previously reported.
23
Resting metabolic rate
RMR of each patient was obtained by indirect calorim-
etry in the Metabolic Unit of the Faculty of Medical Sci-
ences of the State University of Campinas. The procedure
was performed in the morning in a room with low light,
controlled temperature, and no noise. The measurements
were taken using a canopy after the patient had a 30-minute
rest in the supine position. An open-circuit indi-rect
calorimeter (model 29N; Medics Vmax, Yorba Linda, CA)
was used. The respiratory exchanges were monitored
continuously after 10 minutes (equilibrium phase) fol-
lowed by a 30-minute period with data obtained every
minute and averaged over the 30-minute period. RMR
calculated from the oxygen consumption and carbon diox-
ide production rates was expressed as a ratio of fat-free
mass (FFM) in kilocalories per kilogram of FFM and had a
duration of 24 hours.
Clinical laboratory analysis
After phlebotomy, sera were collected by centrifuging
whole blood at 5000 rpm for 12 minutes at 5 C. Insulin,
leptin, and adiponectin were measured in serum samples
using the enzyme-linked immunosorbent assay method
with a specific kit (Millipore Corporation, Billerica, MA),
and blood glucose by the automated enzymatic method
using the bioassay of the glucose YSI modal 2300 STAT
Glucose Analyzer (Yellow Spring, OH). Insulin
 HEAD AND NECK CANCER TREATMENT AND METABOLIC EVALUATION

TABLE 1. Nutritional status at baseline and after treatment. patients had significant weight loss during treatment (67.01
6 13.07 vs 60.61 6 11.80 kg) with consequent reduction in
Nutritional status Baseline (%) After (%) p value* BMI (23.95 6 4.35 vs 21.64 6 3.94 kg). The weight loss
BMI, kg/m
2 was accompanied by a significant reduction in body fat
Underweight III 0(0.00) 2(6.25) .035
percentage (27.27 6 7.44 vs 23.36 6 7.70 kg) and in FFM
Underweight II 0(0.00) 1(3.13)
(Kg; 48.30 6 9.84 vs 45.90 6 8.75 kg) calcu-lated from
skin-fold thickness and bioelectrical imped-
Underweight I 0(0.00) 5 (15.62)
Eutrophic 21(65.62) 18(56.25)
ance. The RMR (kcal/day; 1122.50 6 251.57 vs
Overweight 8 (25.00) 5 (15.62) 961.13 6 232.31) and RMR/FFM (kcal/kg; 23.76 6 4.64
Obesity I 2(6.25) 1(3.13) vs 21.09 6 4.65) before CRT was higher than that found
Obesity II 1(3.13) 0(0.00) after CRT. The mean values of IL-6, TNF-a, and IL-1b
PG-SGA levels, measured before and after CRT in our patients, were
Score A 20(62.50) 9 (28.12) .006 4.44 6 3.37 and 5.50 6 4.17 pg/mL, 3.21 6 4.69 and 2.82 6
Score B 10(31.25) 14(43.76) 4.21 pg/mL, and 0.40 6 0.21 and 0.38 6 0.10 pg/ mL,
Score C 2(6.25) 9 (28.12) respectively.
Reduction in leptin values (4.67 6 1.07 vs 1.51 6 1.02; p
Abbreviations: BMI, body mass index; PG-SGA, Patient Generated 5 .002) and increase in adiponectin values (6.40 6 2.11 vs
Subjective Global Assessment. 11.82 6 8.67; p 5 .043), measured before and after CRT,
* Fisher test for category statistical significance was accepted at p .05.
were seen in patients with tumor resection. No sig-nificant
differences in other metabolic parameters meas-ured before
sensitivity was estimated from fasting glucose and insulin, and after treatment were seen in patients without tumor
according to Matthews et al.
24 resection and in patients submitted to tumor resection (p > .
05; Table 3).
Serum cytokine analysis Patients who underwent tumor resection presented higher
weight, BMI, MC, MMC, and TSF values than those
The aliquots of collected sera were stored in a freezer without surgical resection of the tumor before CRT. Higher
until quantification of IL-6, TNF-a, and IL-1b levels by
enzyme-linked immunosorbent assay method with the resting energy expenditure after CRT was also seen in this
specific kit (R&D Systems, Minneapolis, MN). group of patients, compared to those without tumor
resection (Table 4). Before CRT, the caloric intake (2577.5
Statistical analysis 6 1272.9 vs 2217.7 6 820.3 kcal/day; p 5 .041) of patients
submitted to tumor resection was higher than that of
All data were expressed as means 6 SD. The compari-son patients without resection of the tumor. No difference in
of data between 2 times of treatment (pretreatment and caloric intake was found in patients of each group after
posttreatment) was performed using the Wilcoxon test. To CRT (1958.6 6 602.9 vs 2117.7 kcal 6 820.3; p 5 .102),
compare the variables between the 2 groups (with or respectively.
without tumor resection), the MannWhitney test was used. None of the patients enrolled in this study were under-
The Fisher test was used for comparison of nutri-tional weight before CRT, but the nutritional status, measured by
status (categorical variable) between the groups analyzed PG-SGA before CRT, was slightly better in patients with
pretreatment and posttreatment. SAS for Win-dows 9.1.3 tumor resection than in those without tumor resec-tion. In
(SAS Institute, 20022003, Cary, NC) was used in all contrast, the number of underweight and score C patients
analyses and statistical significance was accepted at p < . after CRT was higher among patients without tumor
05. resection than among patients with tumor resection (Table
5).
Ethical considerations
The institutional ethics committee approved the study,
and each participant signed the informed consent form after TABLE 2. Nutritional status, body composition, and
pertinent information. resting energy expenditure before and after treatment.

RESULTS Baseline/before After

Parameter Mean 6 SD Mean 6 SD p value*
Thirty-two patients with SCCHN treated with CRT par-
ticipated in this study. Twenty patients (7 oral cavity, 6 Weight, kg 67.01 6 13.07 60.61 6 11.80 .001
pharyngeal, and 7 laryngeal; 5 with stage III tumors, and 15 BMI, kg/m2 23.95 6 4.35 21.64 6 3.94 .001
with stage IV tumors) received CRT as a single treat-ment. Body fat, % 27.27 6 7.44 23.36 6 7.70 .005
Twelve patients with SCCHN (6 oral cavity, 3 pha-ryngeal, FFM, kg 48.30 6 9.84 45.90 6 8.75 .032
3 laryngeal; 4 stage III, and 8 stage IV) had undergone TSF, mm 10.84 6 5.78 8.41 6 4.56 < .001
tumor resection before CRT. MMC, cm 24.81 6 3.10 23.17 6 3.07 < .001
There were no significant changes in dietary energy RMR, kcal/d 1122.50 6 251.57 961.13 6 232.31 < .001
(2038.0 6 1013.8 vs 2130.8 6 715.9 kcal/day; p 5 .40) RMR, Kcal/ 23.76 6 4.64 21.09 6 4.65 .002
and/or macronutrient intake in all patients measured pre- FFM, kg
viously and after CRT. However, consistent differences in
2
body composition (BMI kg/m ), PG-SGA (scores A, B, or Abbreviations: BMI, body mass index; FFM, fat-free mass; TSF, triceps skin
C) and RMR (kcal/day) measurements were seen in fold; MMC, mus-cular midarm circumference; RMR, resting metabolic rate.
patients analyzed at these times (Tables 1 and 2). The * Wilcoxon test for statistical significance was accepted at p .05.

HEAD & NECKDOI 10.1002/HED JANUARY 2015 99

CARVALHO ET AL.

TABLE 3. Comparison between groups with and without tumor resection before and after treatment considering metabolic parameters.

Baseline After
Parameter WOR WR p value* WOR WR p value*

Glucose, mg/dL 95.63 6 17.79 93.00 6 9.33 .982 99.29 6 16.96 94.20 6 12.15 .237
Insulin, uU/mL 5.91 6 6.64 4.13 6 1.70 .958 5.91 6 4.21 5.75 6 4.48 .886
Leptin, mg/mL 3.02 6 3.02 4.67 6 1.07 .226 3.14 6 4.89 1.51 6 1.02 .581
Adiponectin, ug/mL 11.99 6 10.97 6.40 6 2.11 .501 16.88 6 14.05 11.82 6 8.67 .843
HOMA-IR 1.35 6 1.48 0.99 6 0.49 .873 1.46 6 0.98 1.31 6 1.03 .422
IL-6, pg/mL 5.68 6 3.96 2.86 6 1.78 .108 5.70 6 4.65 5.12 6 3.36 .867
TNF-a, pg/mL 3.49 6 5.44 2.35 6 2.07 .872 3.48 6 5.20 1.70 6 0.90 .547
IL-1b, pg/mL 0.37 6 0.09 0.47 6 0.33 .694 0.40 6 0.09 0.34 6 0.12 .367

Abbreviations: WOR, without tumor resection; WR, with tumor resection; HOMA-IR, homeostasis model of assessment-insulin resistance; IL, interleukin;
TNF- a, tumor necrosis factor alpha. * MannWhitney test for statistical significance was accepted at p .05.
The values are expressed as means 6 SDs.

DISCUSSION nutritional counseling during radiotherapy was the most

Cachexia is a side effect that is generally observed
among patients on CRT. However, the mechanisms relat-
ing therapy and weight loss have not yet been elucidated.
Some factors, such as changes in RMR, food intake, or
influences related to metabolic changes induced by the
tumor or even by the treatment, may contribute to cachexia.
In our study, a significant decrease in weight after CRT
25
(10%) was observed. A study conducted by Newman et al
demonstrated that patients undergoing CRT for advanced
SCCHN lost about 10% of baseline weight dur-ing
treatment.
Decreases in RMR and RMR/FFM in patients after CRT
26
were seen in our study. Fearon et al also found no
difference in RMR in patients with cancer with and with-
out weight loss. There was no significant difference in
energy intake before and after CRT. Some studies carried
out in patients with cancer have shown that it is difficult to
revert the waste process through nutritional supplemen-
2729
tation/counseling, total parenteral nutrition, or
30
increased spontaneous ingestion, because weight loss is
more involved with inflammatory processes and a defect in
orexigenic signals than a simple decrease in food intake.
31
Ravasco et al concluded that individualized
effective nutritional intervention, ensuring a proper and
sustainable diet, to overcome the predictable deterioration
subsequent to treatment. However, this approach does not
resolve the defect in orexigenic signals.
We found that the weight loss in our patients was caused
by losses in adipose tissue and FFM, suggesting that these
32,33
patients were at the early phase of cachexia. Weight
loss in patients with cancer was described as a result of
depletion of both skeletal muscle mass and adipose tissue
and, although the nonmuscle pro-tein compartment is
relatively sustained, this differentiates cachexia from
34 35
simple starvation. Agustsson et al dem-onstrated an
increase in lipolysis in cachectic patients at an early stage.
This increase may have been stimulated by the tumor-
derived lipid-mobilizing factor, which stim-ulates lipolysis
and increases the oxidation of fatty acids. Beck and
36
Tisdale showed that cancer is sufficient to cause a rise in
the substrate cycle ratio in the absence of high energy
consumption, which contributes to the fat decrease.
Cachexia related to the triacylglycerol/fatty acid substrate
36
cycling rate is even higher.
IL-6 and TNF-a also lead to lipolysis, which 37
impairs
insulin signaling through several mechanisms. We did not
find significant changes in IL-6 levels in our study,

TABLE 4. Comparison between groups with and without tumor resection before and after treatment considering nutritional and metabolic parameters.

Baseline After
Parameter WOR WR p value* WOR WR p value*

Weight, kg 63.37 6 13.18 73.13 6 10.80 .022 57.75 6 12.49 65.38 6 9.14 .039
2
BMI, kg/m 22.89 6 4.35 25.72 6 3.91 .047 20.80 6 3.98 23.03 6 3.61 .094
MC, cm 26.95 6 4.27 30.33 6 3.75 .029 24.83 6 4.30 27.45 6 2.95 .076
MMC, cm 23.79 6 2.85 26.51 6 2.83 .029 22.34 6 3.34 24.55 6 2.00 .052
TSF, mm 10.05 6 5.80 12.17 6 5.75 .037 7.90 6 4.82 9.25 6 4.16 .233
Body fat, % 27.24 6 7.55 27.32 6 7.61 .646 24.46 6 8.61 21.28 6 5.36 .291
FFM, kg 46.19 6 10.11 52.32 6 8.34 .057 43.59 6 9.59 50.29 6 4.65 .023
RMR, kcal, BIA 1403.616 306.93 1590.20 6 253.21 .054 1325.70 6 291.45 1529.10 6 141.38 .023
RMR, kcal, IC 1074.506 207.73 1198.60 6 302.82 .282 945.65 6 234.26 986.92 6 236.94 .669
RMR, kcal/FFM, kg 24.15 6 24.15 23.06 6 5.57 .250 22.12 6 5.08 19.14 6 3.06 .669

Abbreviations: WOR, without tumor resection; WR, with tumor resection; BMI, body mass index; MC, midarm circumference;
MMC, muscular midarm circumference; TSF, triceps skin fold; FFM, fat-free mass; RMR, resting metabolic rate; BIA, bioelectrical impedance
analysis; IC, indirect calorimetry. * MannWhitney test for statistical significance was accepted at p .05.
The values are expressed as means 6 SDs.

100 HEAD & NECKDOI 10.1002/HED JANUARY 2015

 HEAD AND NECK CANCER TREATMENT AND METABOLIC EVALUATION

TABLE 5. Comparison of nutritional status between groups with and without tumor resection before and after treatment.

Baseline After
Nutritional status WOR WR p value* WOR WR p value*

BMI .15 .34

Underweight III 0 (0.00) 0(0.00) 2 (10.00) 0 (0.00)
Underweight II 0 (0.00) 0(0.00) 1 (5.00) 0 (0.00)
Underweight I 0 (0.00) 0(0.00) 3 (15.00) 2 (16.70)
Eutrophic 15 (75.00) 6 (50.00) 12 (60.00) 6 (50.00)
Overweight 4 (20.00) 4 (33.30) 1 (5.00) 4 (33.30)
Obesity I 0 (0.00) 2 (16.70) 1 (5.00) 0 (0.00)
Obesity II 1 (5.00) 0(0.00) 0.00 0 (0.00)
PG-SGA .03 .64
A 9 (45.00) 11(91.70) 5 (25.00) 4 (33.30)
B 9 (45.00) 1(8.30) 8 (40.00) 6 (50.00)
C 2 (10.00) 0(0.00) 7 (35.00) 2 (16.70)

Abbreviations: WOR, without tumor resection; WR, with tumor resection; BMI, body mass index; PG-SGA, Patient Generated
Subjective Global Assessment. * Fisher test for category statistical significance was accepted at p .05.

probably because of the small sample size. However, the
mean value of IL-6 found in our patients was similar to that
38
found by KrzystekKorpacka et al. Diakowska et al
also found a higher concentration of IL-6 in patients with
esophageal cancer with cachexia, although these values
were lower than those found in our study. Evans et al
used IL-6 >4 pg/mL as a parameter to define cancer
cachexia in adults. A study conducted by Ryden et al
confirmed that serum IL-6 levels were sig-nificantly
increased in patients with cancer with cachexia.
Serum IL-6 levels were also32,41inversely correlated with sur-
vival in patients with cancer. IL-6 acts in the muscle
and raises42 protein degradation by activating proteolytic
pathways.
IL-6 induces insulin resistance in human fat cells in
43
vitro. We did not find insulin resistance in our study; the
IL-6 levels may have not been significantly high to affect
insulin sensitivity in our patients. HOMA-IR did not
significantly increase after treatment, suggesting that CRT
did not interfere with the patients insulin sensitivity.
The reduction in leptin and increase in adiponectin val-
ues, measured before and after CRT, were seen only in our
patients who submitted to tumor resection. No con-sistent
differences in TNF-a or IL-1 b were seen in our study.
believe that IL-1b participated in the weight loss of our
patients, even when detected in small quantities, because it
39 53
was the first cytokine to be associated with cachexia,
54
increased lipolysis, and decreased lipogenesis.
It should be pointed out that our patients were at the
40
beginning of the anorexiacachexia process. Comparing the
groups with or without tumor resection, it was observed
17
that the group with tumor resection started treat-ment
showing a better overall nutritional status (scores A and B),
caloric intake, and a greater tendency toward lower
concentrations of inflammatory cytokines.
It should also be emphasized that our patients had sig-
nificant weight loss. The loss of weight was not associ-ated
with changes in RMR and/or any decrease in food
consumption, but predominately with the SCCHN tumor
and CRT, which may increase inflammatory cytokines at
the beginning stages of the anorexiacachexia syndrome.
Early nutrition monitoring and tumor resection seemed to
attenuate anorexia-cachexia syndrome in our patients.
In conclusion, our data suggest that early nutritional
monitoring and surgical tumor resection may be important
factors for patients with SCCHN for improved toleration to
treatment.

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