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The technological evolution and the improvement of the effectiveness of medical therapies in oncology area allowed to improve the outcome in cancer patients. In particular the association between Radiotherapy and Chemotherapy in Head and Neck Cancers (HNC) has permitted to obtain a significant advantage in the control of the overall survival of primary HNC patients. However the chemoradiation (CRT) causes major acute toxicity with a noticeable deterioration of quality of life. A multidisciplinary care pathway for HNC patients has been created in the Radiotherapy Unit of Prato’s Hospital Santo Stefano; the purpose is to obtain an improvement of the quality of life, a reduction of weight loss during CRT treatment and a multiprofessional management of acute toxicities.

A flow-chart was designed by Radiaton TherapisTs (RTTs), Radiation Oncologists and Dietitians and it refers to patients undergoing every-three-weeks and weekly platinum-based CRT regimen. It also illustrates the pathway and the timing of the nutritional intervention. The dietitian evaluated the patients’ nutritional requirements, the need of Oral Nutritional Supplements and/or Artificial Nutrition when the oral intake is lower than estimated needs. During the radiotherapy cycle the patients were weighed three times a week to monitore a possible weight loss. Moreover the RTT daily carried out, by means of the IGRT 3D, the anatomic images of the areas treated with RT, not only to evaluate the set up error but also anatomic changes. The 3D images evaluated the loco regional contour body volume loss with the software MIM MAESTRO by means of Dice Similarity Coefficient (DSC) and Mean Distance to Agreement (MDA), which permitted the comparison of the body contour between the first and the last CBCT (Cone-Beam Computed Tomography) acquired during the treatment.

In this study patients treated with CRT were supported by nutritional intervention (P1) and their datas were evaluated and compared with the population that underwent the same therapy but were treated before the creation of the multidisciplinary care pathway (P2). The weight loss in every patient was analyzed and demonstrated that the multidisciplinary approach lead to a reduction in weight loss. The average weight loss at the end of CRT in P1 was about 6.2 ± 3.8% while in P2 was 10.3 ± 4.3% (p-value<0.001). Comparing the patient body contour between the first and the last CBCT the average DSC in P1 was 0.965±0.014 while in P2 was 0.934 ± 0.016 and the average MDA in P1 was 1.60 ± 0.63mm while in P2 was 2.65 ± 0.81mm (p-value<0.001). Datas are summerized in table 1.

The creation of a multidisciplinary and multiprofessional care pathway for the management of HNC patients treated with CRT allowed to obtain a better outcome of toxicities, an evident reduction in weight and loco regional body volume loss with a consequent improvement of quality of life.