Association of Ghrelin with Anorexia following Chemoradiotherapy for Head and Neck Cancer

Abstract

Anorexia and weight loss as a consequence of chemoradiotherapy (CRT) is a common problem in patients with head and neck squamous cell carcinoma. Weight loss during treatment is a prognostic indicator for overall survival. This study investigates the association between anorexia during CRT and ghrelin, which is known to increase appetite. This observational study focused on patients with oropharyngeal, hypopharyngeal or laryngeal cancer who underwent cisplatin-based chemoradiotherapy. Twenty-one patients were enrolled in this study (oropharynx 5, hypopharynx 10, and larynx 6). A prospective analysis was performed to compare plasma ghrelin concentrations before and after CRT. Mean acylghrelin was significantly lower after treatment (mean=7.2 fmol/ml, SD=7.8) than before CRT (mean=21.0 fmol/ml, SD=38.5, p=0.049). Levels of acylghrelin decreased progressively during treatment with cisplatin-based CRT. Appetite measurements were taken before and two weeks after CRT. Mean ratings for prospective consumption after CRT decreased compared with the baseline. There was a significant correlation between the adverse event of anorexia and plasma ghrelin after CRT. The increase in acylghrelin after administration of cisplatin and radiation mucositis are likely to be a compensatory response to anorexia.