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

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.

The efficacy and safety of Nab-paclitaxel plus gemcitabine versus mFOLFIRINOX in the first-line treatment of metastatic pancreatic cancer: a retrospective study

“…A phase III, randomized, controlled trial showed that early nutrition and psychological intervention could reduce the mortality risk of patients with advanced esophageal cancer by 32% [ 30 ]. A prospective, multicenter, randomized study showed that whole-course nutrition management is helpful to maintain the weight and nutritional status of esophageal cancer patients receiving concurrent radiotherapy and chemotherapy and improving their treatment tolerance and short-term prognosis [ 31 ]. Nutritional support may improve the prognosis of pancreatic cancer, which deserves further attention and research.…”

Multidisciplinary nutritional management improves nutritional and hospitalized outcomes of patients with esophageal cancer undergoing chemoradiotherapy: A randomized control trial

“…This was consistent with the results of previous studies conducted in China, which indicated that a better nutritional status can help reduce the incidence of complications. [21][22][23][24]46] Furthermore, as expected, the length of hospital stay and in-patient costs both decreased in the intervention group owing to better nutritional status and fewer complications.…”

“…Statistically significant differences were observed between the intervention and the control groups. Compared with the control group, the average length of hospital stay decreased by 12 days [47 (40, 50) vs 35 (23,40), P = .001], and in-patient expenses decreased by 20,504 CNY in the intervention group (P = .004).…”

“…[1,[17][18][19][20] In recent years, several studies have indicated the benefits of nutritional support in patients with EC who have received chemoradiotherapy. [10,[21][22][23][24] Qiu et al conducted a randomized control trial of 96 patients with EC undergoing CRT, and found that whole-course nutritional management could effectively improve the levels of ALB and total protein in study participants. [21] Cong et al reported that the prealbumin, transferrin and ALB parameters of participants in the nutrition support team (NST) were much better than those in the control group, whereas the incidence of complications, for example, bone marrow suppression and infections, was lower in the NST group.…”

High protein diet in digestive cancers

“…These results suggest that artificial nutrition, either supplements, enteral or parenteral nutrition, should be frequently considered, proposed and implemented in patients with digestive cancers in order to meet protein targets. Supporting this approach, in malnourished patients with oesophageal carcinoma and treated with concurrent chemoradiotherapy, the use of enteral nutrition yielded to less decrease in body weight, serum albumin and haemoglobin levels, a lower incidence rate of grade !3 myelosuppression and infection, and a higher completion rate of concurrent chemoradiotherapy than those in the control group [12]. Of interest, overall and progression free survival were significantly extended in patients with more severe malnutrition, that is, Patient Generated-Subjective Global Assessment (PG-SGA) ¼ C.…”