Effects of Enteral Nutrition on Patients With Oesophageal Carcinoma Treated With Concurrent Chemoradiotherapy: A Prospective, Multicentre, Randomised, Controlled Study.

Jiahua Lyu,Jing Wang,Jie Li,Tao Li,Wenyan Pan,Liangfang Shen,Hailin Zhang,Guangying Zhu,Daoke Yang,Jinyi Lang,Fang Li,Hanping Shi,Shuchai Zhu,Conghua Xie,Ren Zhao,Ligang Xing,Jianhua Wang,Anhui Shi

doi:10.3389/fonc.2022.839516

Abstract

BackgroundThe oesophageal carcinoma patients show high incidence of malnutrition, which negatively affects their therapy outcome. Moreover, benefits of enteral nutrition remain to be studied in details in these patients. Therefore, we set to assess the effects of enteral nutrition on the nutritional status, treatment toxicities and survival in the oesophageal carcinoma patients treated with concurrent chemoradiotherapy (CCRT).Materials and MethodsEligible patients were randomly assigned to either the experimental or control group. The patients in the experimental group were treated with a whole-course enteral nutrition management, while the control group were provided a unsystematic nutrition without setting intake goals for energy and protein. The primary endpoint was a change in body weight, while the secondary endpoints included nutrition-related haematological indicators, toxicities, completion rate of treatment and survival.ResultsA total of 222 patients were randomised to either the experimental (n=148) or control (n=74) group. Patients in the experimental group showed significantly less decrease in body weight, serum albumin and haemoglobin levels, a lower incidence rates of grade ≥3 myelosuppression and infection, and a higher completion rate of CCRT than those in the control group. While analyses of the 2 and 3 year overall survival (OS) and progression-free survival (PFS) did not reveal differences between these groups, we observed a significantly higher OS at 1 year (83.6% vs. 70.0%). In the subgroup analysis, patients with patient-generated subjective global assessment (PG-SGA)=C were likely to have better OS and PFS with enteral nutrition.ConclusionsIn EC patients treated with CCRT, enteral nutrition conferred positive effects on the nutritional status, treatment toxicities and prognosis, which mandate its inclusion in clinical practice.Clinical Trial RegistrationThis prospective trial has been registered with www.clinicaltrials.gov as NCT02399306.

Highlights

Oesophageal cancer (EC) is a malignant tumour with a high incidence rate and more than 570000 cases are newly diagnosed worldwide every year [1]
The incidence of weight loss and malnutrition is high in patients with oesophageal cancer due to dysphagia, painful swallowing, alterations in metabolism, and adverse effects of radiotherapy and chemotherapy
The basic process is as follows: [1] nutritional risk screening with NRS-2002, nutritional assessment with patient-generated subjective global assessment (PG-SGA); [2] enteral nutrition with oral nutritional supplement (ONS, Nutrison produced by Nutricia) or tube feeding based on the results of nutrition assessment, dietary investigation, degree of dysphagia; [3] timely evaluation of the treatment effect and adjustment of the nutritional program according to the dynamic changes of the nutritional status and adverse effect of patients; [4] quality control of the whole-course nutrition

Summary

Introduction

Oesophageal cancer (EC) is a malignant tumour with a high incidence rate and more than 570000 cases are newly diagnosed worldwide every year [1]. In China, the incidence rate of oesophageal cancer ranks fifth in men and ninth in women [2]. Chemoradiotherapy is an important intervention for patients with oesophageal cancer [3]. The incidence of weight loss and malnutrition is high in patients with oesophageal cancer due to dysphagia, painful swallowing, alterations in metabolism, and adverse effects of radiotherapy and chemotherapy. Oesophageal carcinoma often ranks first in the incidence of malnutrition as 60–85% patients show different degrees of malnutrition [4,5,6]. The oesophageal carcinoma patients show high incidence of malnutrition, which negatively affects their therapy outcome. We set to assess the effects of enteral nutrition on the nutritional status, treatment toxicities and survival in the oesophageal carcinoma patients treated with concurrent chemoradiotherapy (CCRT)

Objectives

Methods

Results

Conclusion