Implications of diabetes in head and neck cancer - A single center real-world data

Diabetes mellitus (DM) and altered glucose metabolism have been associated with carcinogenesis, but also with prognosis and tolerance to treatment in different types of cancer. Head and neck cancers (HNC), the sixth most common malignancy worldwide, require a multimodal approach, especially in advanced stages and cancer specific treatment is often associated with therapeutic failure and severe toxicities even if it is delivered according to current standards. The aim of the study was to evaluate the clinical, biological and outcomes implications of DM in patients with HNC. The cases diagnosed with HNC associated with DM between January 2008 and December 2016 were selected from the database of the oncology clinic and the oncology outpatient clinic of the Craiova County Hospital. Under the limits of a relatively reduced patient lot of 23 cases, certain particular aspects of these cases are highlighted possibly due to the association of DM with HNC. This category of patients should not be treated differently even if a precaution is necessary due to the increased risk of complications related to treatment. The use of Metformin could bring outcome benefit and the treatment of DM with insulin could be associated with a worst prognostic. The use of poly-chemotherapy regimens (platinum double or triple combination including platinum salts) demonstrates the feasibility of using chemotherapy for these subtypes of patients. A tendency to de-escalate the treatment by omitting radiotherapy for this category of patients should also be noted. Neutrophil to lymphocyte ratio (NLR), a less specific biomarker could be less useful than the Glasgow Prognostic Score (GPS) which can be considered an accessible biomarker. A large percent of sinonasal cancers compared to the data reported in the literature could be also related to DM. Both this possible association and the benefit of Metformin and 5-Flurouracil must be reevaluated in studies in larger groups of patients (Ref. 25). Keywords: diabetes, head and neck cancers, metformin, toxicity, outcomes, chemotherapy.