Low Serum Albumin, Body Mass Index, and Feeding Route Predict Treatment Interruptions During Concurrent Chemoradiotherapy in Head and Neck Cancer: A Retrospective Cohort Study

ABSTRACT Objective To identify nutrition‐related predictors of treatment interruption during concurrent chemoradiotherapy (CCRT), the primary outcome and to determine the secondary impact of interruption on 5‐year overall survival (OS). Methods This retrospective cohort study analyzed 440 head and neck cancer (HNC) patients receiving definitive CCRT (January 2013 to December 2016) at a tertiary academic center. Treatment interruption was defined as radiotherapy total treatment time > 56 days or cumulative delay > 7 days, and as chemotherapy delay > 7 days or premature discontinuation. Multivariable logistic regression identified independent predictors; Kaplan–Meier analysis compared 5‐year OS by interruption status and tumor site. Results Among 440 patients (mean age 55 years; 81.7% male), 52.3% experienced chemotherapy interruptions and 14.4% radiotherapy interruptions. Independent nutritional predictors of chemotherapy interruption were: serum albumin < 3.5 g/dL (adjusted OR 2.54, 95% CI 1.19–5.43, p = 0.016), pretreatment BMI category (overall p = 0.032, driven mainly by a protective trend for BMI > 25 kg/m 2 [adjusted OR 0.55, 95% CI 0.30–1.00, p = 0.051]; the < 18.5 kg/m 2 subgroup showed a nonsignificant increase in risk: adjusted OR 1.41, 95% CI 0.84–2.35, p = 0.196), and oral feeding (vs. feeding tube as reference) (adjusted OR 2.27, 95% CI 1.07–4.76, p = 0.030). In non‐nasopharyngeal cancer, radiotherapy interruption significantly reduced 5‐year OS (14.3% vs. 29.9%, p = 0.03). Chemotherapy interruptions did not significantly affect survival. Conclusions Hypoalbuminemia (< 3.5 g/dL), pretreatment BMI category, and feeding route independently predict chemotherapy interruptions in HNC. Radiotherapy interruptions significantly impair survival in non‐nasopharyngeal cancers. These readily available markers should guide pretreatment nutritional optimization and feeding tube consideration in high‐risk patients.