Colasanto Joseph M, Prasad Priyajit, Nash Mary Ann, Decker Roy H, Wilson Lynn D
Yale University School of Medicine, USA.
Oncology (Williston Park). 2005 Mar;19(3):371-9; discussion 380-2, 387.
Malnutrition plays a key role in the morbidity of head and neck cancer patients receiving surgery, chemotherapy, radiotherapy, or combined-modality therapy. In addition to weight lost prior to the diagnosis of head and neck cancer, the patient may lose an additional 10% of pretherapy body weight during radiotherapy or combined-modality treatment. A reduction of greater than 20% of total body weight results in an increase in toxicity and mortality. Severe toxicity can result in prolonged treatment time, which has been implicated in poor clinical outcome. Early intervention with nutritional supplementation can reduce the chance of inferior outcome in patients at high risk of weight loss. The preferred route of nutritional support for these patients is enteral nutrition. Two commonly used methods for enteral feedings are nasoenteric and percutaneous endoscopic gastrostomy. It is important to take into account the ethical considerations involved in providing long-term nutritional support, particularly for patients with terminal conditions. Nutritional directives are best evaluated through multidisciplinary efforts, including input from the patient as well as members of the nursing, nutritionist, and medical staff.
营养不良在接受手术、化疗、放疗或综合治疗的头颈癌患者的发病过程中起着关键作用。除了在头颈癌诊断之前体重就已减轻外，患者在放疗或综合治疗期间可能会再减轻治疗前体重的10%。体重减轻超过总体重的20%会导致毒性增加和死亡率上升。严重的毒性反应会导致治疗时间延长，而这与不良的临床结局有关。对有体重减轻高风险的患者进行早期营养补充干预可降低不良结局的发生几率。这些患者首选的营养支持途径是肠内营养。两种常用的肠内喂养方法是鼻肠管喂养和经皮内镜下胃造口术。提供长期营养支持时，考虑其中涉及的伦理问题很重要，尤其是对于终末期患者。最好通过多学科协作来评估营养指导方针，包括患者以及护理人员、营养师和医务人员的意见。
