Publications

Abstract

Background: The study aims to find the impact of diabetes mellitus (DM) in patients undergoing radiation therapy (RT) for head and neck cancer (HNC).

Materials and methods: The retrospective cohort study analysed 346 HNC patients who received definitive or adjuvant RT with or without chemotherapy from January 2013 to December 2023. The patients were categorized into DM (n = 84) and non-DM (n = 262) group. This study analysed baseline characteristics, compliance, toxicities, and overall survival (OS).

Results: A total of 12 (14.3%) patients in the DM arm and 24 (9.2%) in the non-DM arm did not complete the scheduled RT. Treatment breaks ( > 2 days) occurred in 49 patients (58.3%) in the DM arm vs. 87 (33.2%) in the non-DM arm. Grade ≥ 3 acute toxicities were significantly frequent in the DM arm, including mucositis (61.9% vs. 42.7%), dysphagia (44.0% vs. 26.0%), pain (53.6% vs. 40.1%), febrile neutropenia (34.5% vs. 24.4%), and infections (66.7% vs. 54.2%). Supportive interventions were also significantly higher in the DM arm: antibiotics (60.7% vs. 45.4%), antifungals (51.2% vs. 39.7%), feeding procedures (33.3% vs. 16.8%), hospitalizations (58.3% vs. 40.1%), and Intensive care unit (ICU) admissions (4.8% vs. 2.3%). After 17.15 months’ follow-up, mortality was 47.6% in DM vs. 35.1% in non-DM (p = 0.040), with median OS 35.3 months in DM and not reached in non-DM. Restricted mean survival was significantly higher in the non-DM group (42.3 vs. 34.3 months; p = 0.0059).

Conclusions: This study showed that HNC patients with DM undergoing RT are more susceptible to acute and late toxicities, poor compliance to treatment and significantly poor OS compared to non-DM group.

Keywords: head and neck cancer radiation therapy diabetes mellitus