Squamous Cell Carcinoma of Head and Neck Clinical Trial
Official title:
Evaluation of Optimised Early Management in the Context of Radiochemotherapy for Curatively Treated Squamous Cell Carcinoma of the Head and Neck
Post-operative concomitant radiochemotherapy is a treatment that is difficult to achieve for
several reasons. First of all, and by definition, these patients have had recent surgery,
most often accompanied by several weeks of hospitalization and weight loss. In addition, the
functional recovery of feeding capacity is not always complete at the time of the start of
irradiation. In addition, concomitant radiochemotherapy is responsible for very frequent
radiomucitus which alters the feeding capacity of patients during treatment.
In total, the rate of complete radiochemotherapy (3 cures of cisplatin administered) varies
from 50 to 70% depending on the studies, which were carried out in selected populations
within the framework of an experimental clinical trial and without distinguishing between
positive and negative Human Papilloma tumours . In our experience, in a population with a
very high preponderance of non-Human Papilloma-related tumours and not selected by
participation in an experimental trial, complete radiochemotherapy is only possible in about
40% to 50% of cases.However, the amount of cisplatin actually administered is correlated with
overall survival. Therefore, it is logical to assume that increasing the number of patients
receiving full treatment may result in increased survival.
While the need for nutritional care during radiotherapy is clearly established, its modality
remains debated. Recently, a randomised study of 159 patients treated by radiotherapy (or
radiochemotherapy) showed that the simple systematic prescription of oral food supplements
(500 kcal/d) in addition to the usual dietary advice was associated with a lesser reduction
in weight at the end of radiotherapy (main objective) but also with an improvement in the
tolerance of the treatments. Overall, nutritional management during treatment varies greatly,
ranging from simple dietary monitoring to prophylactic gastrostomy and the insertion of a
nasogastric tube on demand during treatment. This heterogeneity of management found in the
literature is also observed at the regional level. This project will also make it possible to
propose a harmonized support strategy at the inter-regional level.
n/a
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