Daniela Elena Sturzu

Background/Objective: Body mass index (BMI) and treatment-related weight variation have been increasingly investigated as potential prognostic factors in head and neck oncology. However, their role in patients with oropharyngeal squamous cell carcinoma (OPSCC) undergoing concomitant chemoradiation (CRT) remains incompletely defined, particularly in real-world Eastern European populations. The aim of this study was to evaluate the prognostic significance of pretreatment BMI and treatment-induced weight variation in patients with OPSCC treated with curative-intent CRT and to assess their association with survival outcomes. Methods: This single-centre retrospective cohort study evaluated consecutive patients with OPSCC treated with CRT at a Romanian regional oncology centre between 2015 and 2023. Key exclusions were prior surgery or neoadjuvant chemotherapy, palliative care, and secondary malignancies. Clinical variables, baseline comorbidity burden (via Age-Adjusted Charlson Comorbidity Index), and body mass index (BMI) dynamics across treatment timepoints—including pre- and post-CRT BMI, ΔBMI during CRT, and weight loss thresholds ≥5% and ≥10%—were assessed. Overall survival (OS) was analysed using Kaplan–Meier curves, log-rank tests, and Cox proportional hazards multivariate regression to determine independent prognostic factors (p p = 0.01), CRT duration ≥ 47 days (63.2% vs. 92.3%; HR 2.52, p = 0.05), weight loss ≥ 10% (50.0% vs. 71.6%; HR 2.28, p = 0.03), pre-CRT BMI < 24 kg/m² (HR 0.50, p = 0.04), post-CRT BMI < 24 kg/m² (HR 0.40, p < 0.01), and a BMI reduction > 6% (HR 0.50, p = 0.03). On multivariate Cox regression, only age at diagnosis and CRT treatment duration were validated as independent prognostic factors for OS. Conclusions: Weight loss during concomitant CRT and low body mass index were associated with impaired 5-year OS in patients with oropharyngeal squamous cell carcinoma. However, after multivariate adjustment, age at diagnosis, and treatment duration were the sole independent prognostic factors.

Background/Objectives: Financial toxicity (FT) refers to the financial burden directly or indirectly caused by a patient’s medical care. Patients with head and neck cancer (HNC) are particularly vulnerable to FT due to lower rates of return to work and higher out-of-pocket payments (OOPP). In this cross-sectional study, we assessed the amount and types of OOPP, as well as the prevalence of FT, in HNC patients who had completed curative radiotherapy. Methods: We included HNC patients who underwent curative-intent radiotherapy at four private clinics in Romania, within 12 months of completing treatment. Participants completed a 25-item questionnaire capturing sociodemographic information, insurance status, income, and OOPP. To assess subjective FT, we used the validated nine-item Financial Index of Toxicity (FIT), which measures three FT domains: financial stress, financial strain, and lost productivity. Each domain and the total score range from 0 to 100, with higher scores indicating greater financial toxicity. Descriptive statistics were used to summarize patient characteristics. Pearson’s chi-square, t-tests, and one-way ANOVA were used to assess statistical associations, with a significance threshold of p < 0.05. Results: Among 113 patients (mean age: 59), the majority were male (74.3%) and married (74.3%), with 40% having completed university or higher education. The most frequent tumor sites were the oropharynx (29 cases), larynx (22), and oral cavity (21). Concurrent chemoradiation was the most common treatment modality (47%). The mean total FT score was 18.8. Overall, 39.8% of patients experienced financial toxicity, and 29.2% scored above the mean in financial stress. Moderate financial strain (score > 21) was reported by 39.8% of participants, and approximately one-third reported loss of productivity. Transportation and nutritional supplements were the most common OOPP categories. Notably, 42% of patients spent at least 400 euros—equivalent to Romania’s monthly minimum income—on transportation during radiotherapy. FT was significantly associated with employment and marital status, but not with tumor site or treatment type. Conclusions: Among Romanian HNC patients treated with curative radiotherapy, we found substantial OOPP, particularly for transportation and nutritional supplements. While overall FT levels were moderate, divorced patients and those retired due to other chronic conditions were the most vulnerable to financial distress. Financial toxicity can directly affect treatment adherence, survival, and quality of life. By integrating financial counseling, social support, and broader coverage of treatment-related expenses, healthcare systems can mitigate FT for these patients.

Background/Objectives: According to Globocan, Romania has the highest incidence of nasopharyngeal cancer (NPC) in Europe. Our objective was to evaluate the survival data for a cohort of non-Asian patient population treated with curative intent at a tertiary cancer center in Romania. Methods: We retrospectively analyzed 161 patients with histologically proven, non-metastatic NPC treated at our institution between October 2014 and December 2021 with intensity modulated arc radiotherapy (IMRT) with or without neoadjuvant or concomitant chemotherapy according to the stage of the disease. Kaplan-Meier estimates of overall, disease-free, locoregional relapse free and distant metastasis free survival were calculated. The log-rank test was used to determine significant prognostic determinants of overall and disease-free survival. Results: The median age was 50 years (range 19–80), 88% had nonkeratinizing undifferentiated carcinoma. Epstein Barr virus status was not evaluated routinely. 42.2% of patients were stage III and 46% stage IVA disease. Induction chemotherapy was prescribed for 72.7% of patients and 89.4% received concurrent chemotherapy. After a median follow up of 44 months (range: 3.6, 104.7 months), the estimated 3 years overall, disease free, locoregional relapse free and distant metastasis free survival of the entire cohort were 82.6%, 73.3%, 83.2% and 86.3% respectively. On testing interactions, concomitant chemotherapy offered significant survival benefit (HR—0.287; 95% CI 0.137–0.603; p = 0.001) and cumulative Cisplatin dose of more than 100 mg/mp was statistically significant for survival (HR—0.350;95% CI 0.157–0.779; p = 0.01) Conclusions: This is the largest retrospective series of nasopharyngeal cancer from Romania reporting survival data. Despite the high percentage of advanced stage disease our data shows very good disease control. Compliance to optimal concomitant chemotherapy should represent a priority in clinical practice in a non-Asian patient population.