Nutritional effects of surgery, radiation therapy, and adjuvant chemotherapy for soft tissue sarcomas

To determine the nutritional effects of aggressive combined modality cancer therapy, 35 consecutive patients undergoing surgery, radiation therapy, and adjuvant chemotherapy for soft tissue sarcomas of the head, neck, and trunk were prospectively studied. Changes in body weight, total protein, albumin, total lymphocyte count, and creatinine/height ratio were studied. Significant weight loss occurred with surgery, radiation therapy, and doxorubicin/cyclophosphamide, but not methotrexate, chemotherapy. Total protein and albumin did not change significantly with any of the individual therapies. On long-term follow-up (mean 27 months), patients who survived free of sarcoma showed little nutritional morbidity. Patients with progressive sarcoma, however, showed decreases of 9% in body weight (NS), 11% in total protein (p less than 0.01), 17% in serum albumin (p less than 0.05), and 64% in total lymphocyte count (p less than 0.02). These data indicate that aggressive combined modality cancer therapy can have significant acute nutritional effects. Long-term nutritional morbidity, however, is minimal in patients without recurrent disease. In contrast, patients with recurrent disease show severe nutritional deficits which seem more a consequence of the progressive disease than of the aggressive therapy.