3497 - The Impact of Tumor-Induced Nutritional Disorders on the Relationship between G8 Scores and Definitive Radiotherapy Strategies

Purpose/Objective(s): The Geriatric 8 (G8) screening tool was originally developed to assess the nutritional status of elderly. Recently, it has gained attention as a comprehensive health assessment tool, particularly in oncology field. In cancers where tumor-related symptoms cause nutritional disorders, the G8 score may improve with curative treatment. This study investigated the impact of tumor-related nutritional disorders on the relationship between the G8 score and definitive radiotherapy (RT) strategies.

Materials/Methods: We included esophageal cancer (EC), lung cancer (LC), and cervical cancer (CC), for which chemoradiotherapy (CRT) was standard treatment. We analyzed 159 patients aged =65 years who received definitive RT between 2018 and 2022 (102 EC,26 LC,31 CC). The G8 score was acquired at the first visit to the radiation oncology department. The treatment strategy was decided by a multi-disciplinary conference, and the G8 score was not used to determine the treatment strategy. The analysis was conducted by dividing cases into EC, where tumor-related symptoms cause nutritional disorders, and LC/CC, where such disorders do not occur. Patients who received standard RT and standard chemotherapy were categorized into the standard CRT group, those who received non-standard treatment for either RT or chemotherapy were categorized into the reduced CRT group, and patients who received RT alone with curative intent were categorized into the RT group. The Mann-Whitney U test was used to compare the two groups, and statistical significance was set at p<0.05. The Receiver Operating Characteristic (ROC) curve was used to calculate the cutoff value.

Results: The G8 score was significantly lower in EC (p=0.03), with a mean score of 12.1 (range: 4.5-17), compared to 13.3 for LC/CC (range: 7-17). In EC, G8 score was significantly higher for standard CRT group (p<0.01) and significantly lower for RT group (p<0.01) compared to reduced CRT group. In LC/CC, G8 score was significantly higher in the standard CRT group (p=0.04), but no significant difference was observed between the reduced CRT group and the RT group (p=0.64). The G8 score in the RT group was significantly lower in EC (mean 9.5, range: 4.5-14) compared to LC/CC (mean 13.0, range: 8-17) (p<0.01), whereas no significant differences were observed among cancer types in the standard CRT and reduced CRT groups. In EC, the cut-off G8 score for standard CRT was 12.5 and for RT group was 9.5. In LC/CC, the cut-off G8 score for standard CRT was 12.

Conclusion: In elderly patients received definitive RT, the G8 score was significantly lower in EC, where tumor-related nutritional disorders occur. This suggests that definitive RT may be actively chosen even for patients with low G8 scores, anticipating an improvement in nutritional status due to the treatment effect.