Características humorales de los tumores de cabeza y cuello en pacientes tratados con nimotuzumab / Humoral characteristics of head and neck tumors in patients treated with nimotuzumab

Se efectuó un estudio observacional, descriptivo y retrospectivo de 36 pacientes incluidos en el ensayo clínico (fase IV) Seguridad y efectividad del nimotuzumab en tumores de cabeza y cuello, desarrollado en el Hospital Oncológico Conrado Benítez de Santiago de Cuba, desde enero de 2013 hasta diciembre de 2016, con vistas a identificar las características humorales de dichos tumores en los afectados. Se utilizó la prueba t de Student con una significación estadística de p <0,05. Predominaron el sexo masculino en mayores de 60 años de edad, los efectos adversos clínicos y el tumor de faringe; el estadio clínico III y el carcinoma epidermoide bien diferenciado fueron los más frecuentes. No existieron diferencias estadísticamente significativas entre los parámetros de laboratorio antes del tratamiento combinado con nimotuzumab y durante este. Dicho medicamento constituyó una alternativa terapéutica segura, ventajosa y factible como parte del plan terapéutico convencional en las condiciones asistenciales

An observational, descriptive and retrospective study of 36 patients included in the (phase IV) clinical trial Security and effectiveness of nimotuzumab in head and neck tumors was carried out. It was developed at Conrado Benítez Oncological Hospital in Santiago de Cuba, from January, 2013 to December, 2016, aimed at identifying the humoral characteristics of these tumors in the affected patients. The Student t test was used with a statistical significance of p <0.05. There was a prevalence of the male sex in older than 60 years, the clinical adverse effects and the pharynx tumor; the clinical stage III and the well differentiated epidermoid carcinoma were the most frequent findings. There were no statistically significant differences among the laboratory parameters before and during the combined treatment with nimotuzumab. This medication constituted a sure, advantageous and feasible therapeutic alternative as part of the conventional therapeutic plan in assistance conditions

Case-control study of oral disease indexes in individuals with head and neck cancer after antineoplastic therapy / Estudo caso-controle de índices de doenças bucais em indivíduos com câncer de cabeça e pescoço após terapia antineoplásica

ABSTRACT Objective To evaluate the oral health of patients with head and neck cancer after antineoplastic treatment, and to compare them with patients with no history of cancer. Methods A total of 75 patients, divided into Study Group, composed of individuals after antineoplastic treatment (n=30), and Control Group, with individuals with no history of cancer (n=45), aged 37 to 79 years. The oral health status was evaluated through the index of decayed, missing or filled permanent teeth (DMFT), community periodontal index and evaluation of the use and need of prosthesis. All of these items were evaluated according to the criteria recommended by the World Health Organization. The statistical analysis was descriptive and used the Pearson's χ2 test. Results The community periodontal index was higher in the Study Group when compared to the Control Group (p<0.0001). The need for an upper (p<0.001) and lower (p<0.0001) prostheses was higher in the Study Group. Also, the use of upper prosthesis was higher in the Study Group (p<0.002). The missing or filled permanent teeth index between the two groups (p>0.0506) and the use of lower prosthesis (p>0.214) did not present a relevant statistical difference. Conclusion Periodontal disease and edentulism are the most significant changes in individuals who received antineoplastic therapy for head and neck cancer as well as greater need for oral rehabilitation.

RESUMO Objetivo Avaliar a saúde bucal de pacientes com câncer de cabeça e pescoço após tratamento antineoplásico, e compará-los com pacientes sem histórico de câncer. Métodos Foram avaliados 75 pacientes, divididos em Grupo de Estudo de indivíduos após tratamento antineoplásico (n=30) e Grupo de Controle de indivíduos sem histórico de câncer (n=45), com faixa etária de 35 a 79 anos. A condição de saúde oral foi avaliada pelo índice de dentes permanentes cariados, perdidos e obturados (CPOD), pelo índice periodontal comunitário e por uma avaliação de uso e necessidade de prótese, conforme critérios preconizados pela Organização Mundial da Saúde. A análise estatística foi descritiva e realizada por meio do teste do χ2 de Pearson. Resultados O índice periodontal comunitário foi maior no Grupo de Estudo quando comparado ao controle (p<0,0001). A necessidade de prótese superior (p<0,001) e inferior (p<0,0001) foi maior no Grupo de Estudo. O uso de prótese superior foi maior no Grupo de Estudo (p<0,002). O índice de dentes permanentes cariados, perdidos e obturados entre os dois grupos (p>0,0506) e o uso de prótese inferior (p>0,214) não apresentaram diferença estatística relevante. Conclusão A doença periodontal e o edentulismo são as alterações mais significativas em indivíduos que receberam terapia antineoplásica de câncer de cabeça e pescoço, assim como maior necessidade de reabilitação oral.

Estudo prospectivo randomizado de duplo cego de dois protocolos de cobertura antibiótica na prevenção de osteorradionecrose em pacientes tratados com radioterapia de cabeça e pescoço / Prospective randomized double blind study of two antibiotics protocols for the prevention of osteoradionecrosis following dental extractions in irradiated head and neck cancer patients

A osteorradionecrose (ORN) dos maxilares é uma grave complicação do tratamento radioterápico do câncer de cabeça e pescoço. A realização de exodontias em pacientes que realizaram radioterapia de cabeça e pescoço aumenta o risco de ocorrer osteorradionecrose. Foi realizado estudo prospectivo randomizado e duplo cego com dois protocolos antibióticos utilizados para prevenir a ocorrência de ORN. Pacientes do grupo 1 (G1) utilizaram cobertura antibiótica com amoxicilina 500 mg, a cada 8 horas, via oral, por 8 dias iniciando um dia antes da exodontia, pacientes do grupo 2 (G2) utilizaram cobertura antibiótica com amoxicilina 500mg a cada 8 horas via oral, por 4 dias, iniciando um dia antes do procediemento, continuando por 3 dias após a cirurgia, e utilizando placebo de igual aparência por 4 dias. Onze pacientes foram incluídos no estudo sendo 10 deles do sexo masculino. A idade média dos pacientes foi de 56± 7anos, e 63,6% utilizaram mais de 6.000 cGy durante a radioterapia. Foram realizados 36 procedimentos cirúrgicos, e 51 dentes foram extraídos. Dois pacientes (18,1%) apresentaram três áreas (5,9%) com sinais de ORN em um período médio de acompanhamento de 10± 7 meses. Todos as áreas necróticas ocorreram em região posterior (pré-molares e molares), apresentavam um ou os dois dentes com presença de lesão radiográfica, ocorreram após cirurgias com duração maior que 13 minutos, e apresentavam 1 ou 2 dentes com doença periodontal como motivo da exodontia. Duas áreas necróticas ocorreram em mandíbula, e um em maxila. Não houve diferença estatisticamente significante entre a prevalência de sinais de ORN quando considerado o número de pacientes, procedimentos cirúrgicos realizados, dentes extraídos ou o protocolo antibiótico utilizado. O protocolo utilizado por G2 reduziu o risco de sinais de ORN em pacientes que receberam tratamento radioterápico em região de cabeça e pescoço e que necessitaram remover dentes devido a doença periodontal.

Osteoradionecrosis (ORN) of jaws is a severe complication of head and neck cancer radiotherapy. Dental extractions in irradiated head and neck cancer patients increases ORN risk. A prospective, randomized, double blind study with two different ORN prevention antibiotics protocols were performed. Group 1 patients (G1) received 8th hourly oral amoxicillin 500mg for 8 days starting 1 day pre extraction, and group 2 patients (G2) received 8th hourly oral amoxicillin 500mg for 4 days starting 1 day pre extraction, followed by 4 days of a same appearance placebo drug. A total of 11 patients (10 male and one female) underwent extractions of teeth. Mean age of the patients was 56± 7 years, and 63,6% received more than 6.000cGy radiation dosages. Thirty-six surgery procedures were performed, and 51 teeth were extracted. After a mean follow-up period of 10± 7 months three ORN signals (maxilla 1/mandible 2) were reported, in 2 (18,1%) patients. Necrotic areas envolve theposterior region of jaws, presented previous radiographic lesion, had more than 13 minutes of surgery time, and envolved teeth with periodontal disease. No difference in ORN prevalence beetwen groups of patients, surgical procedures, or removed teeth were detected. The G2 protocol decreased ORN risk when teeth with periodontal problems were extracted.

Hypokalemia during the early phase of refeeding in patients with cancer

OBJECTIVE: Refeeding syndrome occurs in patients with severe malnutrition when refeeding begins after a long period of starvation. This syndrome increases the risk of clinical complications and mortality. Hypophosphatemia is considered the primary characteristic of the syndrome. The aim of our study was to investigate the presence of other electrolyte alterations in patients with cancer during the early stage of refeeding. METHODS: In this observational study, we enrolled 34 patients with cancer of the upper aerodigestive tract receiving upfront radiotherapy who were also enrolled in a nutrition program. A caloric intake assessment, anthropometric measurements and biochemical laboratory tests were performed. RESULTS: Significant weight loss (∼20%) was found in these patients. In the patients receiving artificial nutrition, we found lower levels of potassium and total protein compared with those who were fed orally (p = 0.03 for potassium and 0.02 for protein, respectively). Patients on enteral tube feeding had a higher caloric intake compared with those who were fed orally (25±5 kcal/kg/day vs. 10±2 kcal/kg/day). CONCLUSION: Hypokalemia, like hypophosphatemia, could be a complication associated with refeeding in patients with cancer. Hypokalemia was present in the early stages of high-calorie refeeding. .

Valor da PET/CT na abordagem do câncer de cabeça e pescoço / Value of PET/CT in the approach to head and neck cancer

OBJETIVO: Avaliar a PET/CT na abordagem de pacientes com câncer de cabeça e pescoço. MATERIAIS E MÉTODOS: Estudo retrospectivo de 63 prontuários e exames de PET/CT de pacientes com câncer de cabeça e pescoço. RESULTADOS: Foram encontradas alterações em 76% dos exames. Destes, 7 (11%) foram considerados falso-positivos, com SUV < 5,0. A PET/CT mostrou-se negativa em 15 situações (24%). Dos 14 casos nos quais se utilizou o exame para estadiamento, em 3 (22%) houve aumento no estadiamento. CONCLUSÃO: A PET/CT mostra-se como exame de potencial valor na rotina de avaliação de pacientes com câncer de cabeça e pescoço, entretanto, necessitamos de maior número de casos para definirmos protocolo de uso.

OBJECTIVE: To evaluate the role of PET/CT in the approach to patients with head and neck cancer. MATERIALS AND METHODS: Retrospective study of medical records and PET/CT images of 63 patients with head and neck cancer. RESULTS: Alterations were observed in 76% of the cases. Out of these cases, 7 (11%) were considered as false-positive, with SUV < 5.0. PET/CT demonstrated negative results in 15 cases (24%). Among the 14 cases where the method was utilized for staging, 3 (22%) had their stages changed. CONCLUSION: PET/CT has shown to be of potential value in the routine evaluation of patients with head and neck cancer, but further studies of a higher number of cases are required to define a protocol for utilization of the method.

Symptoms of depression in patients with cancer of the head and neck undergoing radiotherapy treatment: a prospective study / Sintomas de depressão nos pacientes com câncer de cabeça e pescoço em tratamento radioterápico: um estudo prospectivo / Síntomas del depresión en los pacientes con cáncer de cabeza y cuello en tratamiento radioterápico: un estudio prospectivo

This study aimed to investigate the frequency of symptoms of depression in patients with cancer of the head and neck undergoing radiotherapy treatment, in the initial, middle and final stages of the treatment. This is a prospective exploratory quantitative study of 41 patients with head and neck cancer, undergoing radiotherapy treatment in the Oncology Outpatient Clinic of the Beneficência Portuguese Hospital of Ribeirão Preto. Data were collected through the Beck Depression Inventory instrument, and analyzed quantitatively by means of the Statistical Package for the Social Sciences. Symptoms of dysphoria were found to increase throughout the treatment, as well as the number of patients with depression. The results show the importance for the healthcare professionals to detect the prevalence and the levels of the symptoms of depression, since these symptoms tend to increase and may lead to consequences such as a lack of adherence to treatment and a decrease in the quality of life of these patients.

Este estudo teve como objetivo identificar a frequência dos sintomas de depressão nos pacientes com câncer de cabeça e pescoço, em tratamento radioterápico, no início, meio e final do tratamento. Trata-se de estudo exploratório prospectivo, com abordagem quantitativa, de 41 pacientes com câncer de cabeça e pescoço, em tratamento radioterápico no Ambulatório de Oncologia do Hospital Beneficência Portuguesa de Ribeirão Preto. Os dados foram coletados por meio do instrumento inventário de depressão de Beck, e analisados de modo quantitativo, por meio do programa Statistical Package of Social Science. Conclui-se que os sintomas de disforia aumentaram ao longo do tratamento, assim como o número de pacientes com depressão. Os resultados mostram a importância de os profissionais da saúde detectarem a prevalência e os níveis dos sintomas de depressão, uma vez que esses sintomas tendem a aumentar, podendo levar a consequências como falta de aderência ao tratamento e diminuição da qualidade de vida desses pacientes.

El objetivo de este estudio fue investigar la frecuencia de los síntomas de depresión en pacientes con cáncer de cabeza y cuello en el principio, medio y final del tratamiento radioterápico. Se trata de un estudio prospectivo, exploratorio y cuantitativo realizado con 41 pacientes con cáncer de cabeza y cuello en tratamiento de radioterapia en la Clínica de Oncología del Hospital Beneficencia Portuguesa de Ribeirão Preto. Los datos fueron recolectados a través del Inventario de Depresión de Beck y analizados cuantitativamente en el programa Statistical Package of Social Science. Como resultados se obtuvo los síntomas de disforia aumentaron durante el tratamiento, así como el número de pacientes con depresión. Los resultados muestran la importancia de los profesionales de salud en detectar los niveles y la prevalencia de síntomas de depresión, ya que estos síntomas tienden a aumentar y pueden llevar a consecuencias como la falta de adherencia al tratamiento y disminución de la calidad de vida de los pacientes.

Efeitos da radioterapia sobre as condições bucais de pacientes oncológicos / Effects of radiotherapy on the oral consitions of oncologic patients

o presente estudo avaliou as condições bucais de 50 pacientes oncológicos submetidos à radioterapia de cabeça e pescoço (rT). os exames clínicos foram realizados antes do tratamento, imediatamente após 30 dias da rT e 6 meses após a conclusão da rT. As condições periodontais foram avaliadas segundo os critérios do Periodontal screening and recording (Psr) e determinou-se a necessidade de tratamento odontológico. A presença de xerostomia, mucosite e outros efeitos colaterais da rT foi também avaliada. Os pacientes irradiados logo após o início da radioterapia desenvolvem severa mucosite, dermatite, disgeusia, xerostomia e, em menor extensão, candidose. Após a conclusão da radioterapia, 68% dos pacientes apresentavam mucosite grau III ou IV. Verificou-se que o desenvolvimento de mucosite dificulta a higiene bucal, o que colabora para exacerbar a inflamação nos tecidos periodontais. Os dados do presente estudo mostraram que a principal causa de abandono da RT e da severidade das sequelas da RT dependem das condições bucais dos pacientes antes do início do tratamento e da ausência de tratamento odontológico prévio à RT.

Acupuncture for the prevention of radiation-induced xerostomia in patients with head and neck cancer

The aim of this study was to evaluate the effectiveness of acupuncture in minimizing the severity of radiation-induced xerostomia in patients with head and neck cancer. A total of 24 consecutive patients receiving > 5000 cGy radiotherapy (RT) involving the major salivary glands bilaterally were assigned to either the preventive acupuncture group (PA, n = 12), treated with acupuncture before and during RT, or the control group (CT, n = 12), treated with RT and not receiving acupuncture. After RT completion, clinical response was assessed in all patients by syalometry, measuring the resting (RSFR) and stimulated (SSFR) salivary flow rates, and by the visual analogue scale (VAS) regarding dry mouth-related symptoms. Statistical analyses were performed with repeated-measures using a mixed-effect modeling procedure and analysis of variance. An alpha level of 0.05 was accepted for statistical significance. Although all patients exhibited some degree of impairment in salivary gland functioning after RT, significant differences were found between the groups. Patients in the PA group showed improved salivary flow rates (RSFR, SSFR; p < 0.001) and decreased xerostomia-related symptoms (VAS, p < 0.05) compared with patients in the CT group. Although PA treatment did not prevent the oral sequelae of RT completely, it significantly minimized the severity of radiation-induced xerostomia. The results suggest that acupuncture focused in a preventive approach can be a useful therapy in the management of patients with head and neck cancer undergoing RT.

La edad avanzada no justifica el tratamiento subóptimo en el cáncer de la cabeza y cuello; revisión de la litaratura / Age alone should not be a reason for substandard treatment in patients with head and neck cancer; a review of literature

Los pacientes ancianos con neoplasias de cabeza y cuello a menudo no reciben el tratamiento adecuado. Muchos trabajos muestran que se puede realizar el tratamiento quirúrgico radical sin peligro en pacientes ancianos siempre que no existan otras enfermedades asociadas. La radioterapia es tolerada muy bien incluso por los muy ancianos. Los datos sobre quimioterapia combinada en esta población son muy escasos. La comorbilidad grave influye en la tasa de complicaciones posoperatoria y puede limitar la tolerancia a la quimioterapia. Una evaluación minuciosa del estado de salud del paciente previa al tratamiento y la optimización de su estado clínico son fundamentales en los ancianos. Sin embargo, en un análisis multivariado se demostró que incluso después de corregir la comorbilidad y otros factores, se mantenía el efecto de la edad sobre la elección del tratamiento. Las opiniones personales de los cirujanos de cabeza y cuello, los pacientes y sus familiares acerca de la tolerancia al tratamiento y la calidad de vida posterior pueden influir en la elección de la terapia. No obstante, el estudio de calidad de vida mostró que el impacto del tratamiento sobre la calidad de vida no difería entre los pacientes más jóvenes y más ancianos con cáncer de cabeza y cuello. Las presunciones erróneas de que "los ancianos son menos capaces de afrontar un tratamiento mayor" no deben jugar un papel en la elección terapéutica: Siempre se debe considerar el tratamiento estándar si no existen contraindicaciones graves.

Dental needs in brazilian patients subjected to head and neck radiotherapy

In spite of its recognized benefits in the treatment of malignant tumors, radiation therapy have several side effects in the head and neck region. The evaluation of oral conditions by a dentist is important to prevent or minimize these problems. The aim of this retrospective review was to analyze the dental needs in 357 patients who received radiotherapy in the head and neck region and were treated at Orocentro/FOP/UNICAMP, between January 1990 and December 2004. Review of patient files showed that dental examination before radiotherapy was not performed in 148 patients (41.5 percent) and was done in 209 patients (58.5 percent). From the total of examined patients, 94 (45 percent) did not require dental procedures at the moment of examination, while 115 (55 percent) presented some sort of dental need. Following the patients after the radiotherapy, it was observed that the group of patients that was evaluated before radiation presented less need of restorations, root canal filling and dental extractions than those who were not evaluated. The results of this study confirm that the evaluation of oral conditions prior to radiotherapy is essential to minimize the dental needs, emphasizing the importance of the dentist in the multidisciplinary team that treats cancer patients.

Apesar dos benefícios da radioterapia no tratamento de tumores malignos, vários são os seus efeitos colaterais na região de cabeça e pescoço. Sendo assim, a avaliação das condições bucais pelo cirurgião dentista é fundamental para prevenir e/ou minimizar estes danos. Este estudo retrospectivo teve como objetivo verificar as condições dentárias e as necessidades de tratamento odontológico dos 357 pacientes que receberam radioterapia na região de cabeça e pescoço, atendidos pelo Orocentro/ FOP/UNICAMP, no período de janeiro de 1990 a dezembro de 2004. Em 148 (41,5 por cento) do total dos pacientes a avaliação odontológica não foi realizada previamente à radioterapia. A avaliação odontológica pré-radioterápica foi realizada em 209 pacientes (58,5 por cento) dos quais 94 (45 por cento) não tinham necessidades de tratamento odontológico no momento da avaliação, enquanto 115 (55 por cento) apresentavam algum tipo de necessidade odontológica. O grupo de pacientes avaliados antes da radioterapia apresentou menores necessidades de restaurações, endodontias e exodontias que os pacientes não avaliados. Conclui-se que a avaliação das condições bucais previamente à radioterapia é essencial para diminuir as necessidades de tratamento odontológico enfatizando a importância da participação do cirurgião-dentista na equipe multidisciplinar que trata pacientes com câncer.

Dental management of low socioeconomic level patients before radiotherapy of the head and neck with special emphasis on the prevention of osteoradionecrosis

Head and neck cancer patients need to receive dental care previously to radiotherapy. Even patients who regularly visit dental offices need special attention including profilatic and curative treatments. The purposes of this study were to evaluate the dental status of Brazilian head and neck squamous cell carcinoma patients with low socioeconomic level as well as to discuss the dental treatment performed and the oral side effects of radiotherapy. Forty patients with head and neck squamous cell carcinoma received dental care and dental extractions prior to radiotherapy and were were followed up for a mean period of 28.7 months after the cancer treatment. Before radiotherapy, 28 patients were dentulous and 12 edentulous, and all of them had poor oral health and hygiene. The most common treatment performed were dental extraction and 23 patients had 8.6 teeth extracted on average. One out of 9 (11.1 percent) patients developed radiation caries and 5 out of 23 cases (21.3 percent - Group I) developed osteoradionecrosis, being only 1 case associated with previous dental extraction. Brazilian low-socioeconomic level patients with head and neck cancer were submitted to multiple dental extractions due to poor dental condictions and inadequate oral care. The dental treatment did not prevent osteoradionecrosis, which presumably presented a multifactorial etiology in most cases.

Pacientes portadores de carcinomas espinocelulares em cabeça e pescoço necessitam receber tratamento odontológico antes da radioterapia. Mesmo pacientes que visitam regularmente consultórios odontológicos requerem especial atenção incluindo profilaxias e tratamentos curativos. Os objetivos desse estudo foram avaliar a condição odontológica de 40 pacientes de baixo nível sócio-econômico antes da radioterapia em cabeça e pescoço e discutir o tratamento odontológico realizado. Os pacientes foram acompanhados durante o tratamento oncológico. Antes da radioterapia, 28 pacientes eram dentados e doze edêntulos, sendo que todos esses apresentavam péssimas condições sistêmicas e higiene oral deficiente. O tratamento mais comumente empregado foi a extração dentária e 23 pacientes tiveram a média de 8,6 dentes extraídos (Grupo I). Um em 9 (11,1 por cento) pacientes desenvolveram cárie por radiação e 5 em 23 (21,73 por cento) osteorradionecrose, sendo um caso associado a extrações dentárias prévias à radioterapia e outros de origem multifatorial. Pacientes de baixo nível socioeconômico com carcinoma espinocelular em cabeça e pescoço receberam múltiplas extrações dentárias devido à condição dentária precária e má higienização. O tratamento odontológico não preveniu a osteorradionecrose, que apresenta origem multifatorial na maioria dos casos.

Braquiterapia de alta taxa de dose associada a radioterapia externa no tratamento de angiossarcoma extenso do couro cabeludo: relato de caso / Combination of high-dose rate brachytherapy and external beam radiotherapy for the treatment of advanced scalp angiosarcoma: case report

Os autores apresentam um caso de extenso angiossarcoma do couro cabeludo submetido a radioterapia exclusiva, pela associação de roentgenterapia de ortovoltagem e braquiterapia de alta taxa de dose utilizando um molde. Descrevem os aspectos clínicos, técnicos e a evolução terapêutica. Destacam as particularidades e a utilidade da braquiterapia de alta taxa de dose, nesta situação em particular, e fazem uma análise comparativa das dificuldades e limitações caso a braquiterapia de baixa taxa de dose fosse empregada. Concluem ser a braquiterapia de alta taxa de dose uma opção útil, prática e segura para as lesões neoplásicas superficiais do escalpe, podendo ser considerada uma alternativa ao tratamento com elétrons.

Acompanhamento nutricional de pacientes em radioterapia / Nutritional assistance to patients during radiotherapy

With the aim of assessing the possible benefits of nutritional therapy, 140 patients were prospectively studied during radiotherapy of the head and neck (81) and esophageal cancer (19). Mean age was 56.0 (17-80), with 114 males and 26 females. Duration of both nutrition and radiotherapy was 78.0 +/- 45 days. Tube feeding was the primary modality in 50.7 of the population, and oral regimens in the remaining 49.3, but associations between the methods were also used. Enteral diets were supplied under the supervision of a specialized tem for home alimentation (PROSNED). Compliance to the program was 100, and a lymphocyte count diminished along this period (1933 +/- 1033 vs 1265 +/- 688, p. 0.001). A subjective improvement was reported by 84 of the population, and total calorie intake, that was below 60 of estimated needs in 100 of the cases initially, significantly improved to just 40 inadequate at the end of the observations. Radiotherapy was associated with mucositis in 21 of the patients, taste changes in 79, xerostomy in 81, anorexia in 66 and odinophagia in 59. In the individuals selected for enteral feeding, side-effects were represented by technical problems (20) and gastrointestinal disorders (13). All patients completed the nutritional support program and there was no mortality in this series. It is concluded that; 1) Early nutritional support during radiotherapy was able to maintain or improve the nutritional status; 2) Tube feeding, alone or in combination with oral diets, was indicated whenever appropriate and contributed to fulfillment of the energy requirements; 3) Reduction of total lymphocytes could not be prevented by the mentioned therapy; 4) Complications of enteral alimentation were mild and affected a small proportion of the population; 5) Troubles induced by radiotherapy were as frequent as expected, and tended to disturb the intake of food; 6) The compliance to the therapeutic plan was excellent and can be attributed to the efforts of the multidisciplinary team as well as to the help of the specialized home alimentation unit (PROSNED): Diet therapy. Cancer. Nutritional assessment. Radiotherapy. Nutritional support.