206 Chapter 6 function are interrelated. The number of OU and having functional dentures were positively associated with masticatory performance in a prospective cohort study [11]. A retrospective single center study in oral cancer patients showed that patients lacking OU had an increased risk for swallow impairment [37]. Therefore, an association between a deterioration of dental status, resulting in reduced masticatory performances, and weight loss seems conceivable. Tooth extractions or functional units did not predict TF dependency. In a recent study in 450 LAHNSCC patients, nine associative values were added to a prediction model for the need for TF, including amongst others BMI and percentage weight change at baseline [38]. Since we only found type of systemic therapy (cisplatin vs. cetuximab) and RT dose to the submandibular gland as independent TF predictors in the present study population, we have to assume that the study is underpowered and that these preliminary results should be interpreted with caution. This is the first study addressing the impact of pre-CRT/BRT tooth extractions to reduce the risk of ORN, on weight loss. This weight loss is known to have a negative effect on treatment-related toxicity and oncological outcome. By evaluating the CRT/BRT trajectory, including neat weight reporting, a reliable retrospective assessment was possible. The addition of chemotherapy to RT as radiosensitizer does not only enhance RT efficacy, but may also intensify side effects, including nausea, vomitus, mucositis, and weight loss [39, 40]. As a result, the percentage of patients who become TF-dependent during CRT/BRT could be higher than during RT as a single modality. Therefore, we focused on the vulnerable CRT/BRT group to answer our research question. Despite the fact that the research was set up on the basis of strictly standardized usual care protocols, we have some limitations to address. The relatively small sample size impeded extensive subgroup stratification and multivariable corrections. The number of patients who were edentulous at baseline was relatively high. Edentulous patients may have had extractions (e.g., root tips or impacted wisdom teeth), but loss of a functional unit or decrease of the Eichner index is not possible. This may explain why extractions emerged as an associative factor for >5% weight loss and the decline in OU and Eichner Index did not reveal an association with weight loss. Although we were able to identify many factors associated with weight loss after tooth extractions, information on socio-economic and education status, factors associated with health perception, could not be retrieved from the electronic health records, as this information was not reported.
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