Enteral nutrition for esophageal cancer patients with concurrent chemoradiotherapy

目的探讨食管癌放化疗患者联合或不联合肠内营养治疗对患者体重、营养状况、疗效和毒副反应的影响。方法符合入组条件的食管癌患者，随机分为试验组和对照组。两组患者均接受至少2个周期的多西他赛联合顺铂方案化疗及同步放疗。试验组在同步放化疗及自然饮食的基础之上，根据患者吞咽梗阻程度、饮食结构和进食量不同给予（10~25）kcal/(kg·d)的肠内营养制剂补充。主要研究终点为患者体重变化，次要研究终点包括营养相关指标、治疗毒副反应和疗效。结果2014年9月至2016年2月，共入组88例患者，其中试验组58例，对照组30例。两组患者一般资料无差异，试验组体重平均丢失（2.26±0.64）kg，低于对照组（5.45±2.94）kg（P＞0.05）。试验组体质指数降低0.88±0.25，低于对照组2.08±1.12（P＞0.05）。试验组在营养相关指标如血红蛋白、血清白蛋白、淋巴细胞总数等方面均优于对照组，但除血清白蛋白外，差异无统计学意义（P＞0.05）。客观缓解率试验组为90.4%，对照组为86.7%（P＞0.05）。不良反应方面，试验组≥3级血液不良反应显著低于对照组（31.1% vs.45.7%，P＜0.05）。急性放射性肺炎、放射性食管炎发生率两组患者无差异（P＞0.05）。结论肠内营养治疗可以减少食管癌患者放化疗期间的体重下降，改善患者营养状况和提高治疗耐受性，降低毒副反应，但还需要进一步扩大样本量研究。Objective To evaluate the change of body weight, nutritional status, efficacy and safety of concurrent chemoradiotherapy combined with or without enteral nutrition for esophageal carcinoma.Methods Patients with esophageal carcinoma in accordance with inclusion criteria were randomly assigned to experimental group and the control group. Both groups of patients received at least 2 cycles of chemotherapy with cisplatin and docetaxel every 3 weeks concurrent with radiotherapy. Patients in concurrent chemoradiotherapy experimental group received enteral nutrition containing 10~25kcal/(kg·d) according to swallowing obstruction,dietary structure,amount of food intake, in addition to regular diets. The primary end point was weight loss and the secondary end points were nutrition related index, toxicity and clinical effect.Results Between Sep. 2014 and Feb. 2016, 88 patients were enrolled and divided into the experimental group (n=58) and the control group (n=30). The baseline clinical characteristics of the 2 groups were similar. The average loss of body weight of experimental group was lower than the control group [(2.26±0.64)kg vs. (5.45±2.94)kg,P>0.05]. The average loss of body mass index in experimental group was lower than the control group (0.88±0.25 vs. 2.08±1.12,P>0.05). The nutrition related indicators such as hemoglobin, serum albumin, total lymphocyte count of experimental group were better than the control group, there were no statistical differences except for serum albumin (P>0.05). The objective remission rate of the experimental group was 90.4%, while the control group was 86.7% (P>0.05). In adverse reactions, experimental group with equal or greater than grade 3 hematologic adverse reactions were signiifcantly lower than the control group (31.1% vs. 45.7%,P<0.05). The acute radiation esophagitis and acute radiation pneumonia were no statistical differences (P>0.05).Conclusions Enteral nutrition can reduce the weight loss of esophageal cancer patients during chemoradiotherapy, improve nutritional status and treatment tolerance, reduce toxicity, but we need to enroll more patients to conifrm these results.吴阶平基金会课题中国科技核心期刊(ISTIC)4239-242