Skeletal muscle status and malnutrition as predictors of short‐term radiotherapy response and oral mucositis in head and neck cancer

Abstract Objective This study aimed to investigate whether baseline skeletal muscle status and malnutrition in patients with locally advanced head and neck cancer (HNC) are associated with short‐term treatment outcomes and acute radiation oral mucositis (OM). Methods We retrospectively analyzed data from 68 patients with stage III–IV HNC treated at a single center with definitive radiotherapy (66–70 Gy) with or without chemotherapy (induction and/or concurrent) between July 2021 and July 2023. Malnutrition was diagnosed using the Global Leadership Initiative on Malnutrition (GLIM) criteria and Patient‐Generated Subjective Global Assessment (PG‐SGA). Short‐term response was assessed at first post‐treatment imaging after radiotherapy according to RECIST 1.1, and OM severity was graded using World Health Organization criteria. Univariate and multivariate logistic regression analyses evaluated the correlation between short‐term response and grades III–IV OM. Results Of the 68 patients, 32.4% had a lower skeletal muscle index (SMI), 26.5% had lower hand grip strength (HGS), 20.6% (GLIM) and 58.8% (PG‐SGA) had malnutrition. At the end of treatment, 64.7% of the patients achieved partial remission, and 35.3% achieved a stable condition. Low HGS was associated with low short‐term efficacy ( OR = 0.31, 95% CI = 0.10–0.95, p = 0.040); however, this difference did not reach statistical significance in the multivariate model. A total of 41.2% of patients had Grade III–IV OM; however, OM was not significantly associated with low SMI, HGS, or malnutrition. Conclusion Baseline skeletal muscle status and malnutrition did not consistently predict short‐term treatment outcomes or severe radiation‐induced OM in patients with locally advanced HNC. However, these results suggest a potential relationship between low HGS and treatment response. Further research with larger sample sizes and longitudinal evaluations is needed to clarify muscle and nutritional status impact on multidimensional outcomes in this patient population.