School of Exercise and Nutrition Sciences, Deakin University, Burwood Highway, Burwood VIC 3125, Melbourne, Australia.
Clin Nutr. 2011 Feb;30(1):92-8. doi: 10.1016/j.clnu.2010.07.015. Epub 2010 Aug 17.
BACKGROUND & AIMS: Patients with gastrointestinal cancers are susceptible to nutritional deterioration which may be compounded by radiotherapy treatment toxicities. This study aimed to determine whether nutritional status at radiotherapy commencement or changes in nutritional status throughout radiotherapy were associated with treatment toxicity and outcomes in gastrointestinal cancer patients.
Seventy-three gastrointestinal cancer patients receiving curative radiotherapy underwent medical record audits assessing body weight, radiotherapy toxicity, unplanned treatment breaks or hospital admissions and completion of prescribed treatment/s. Nutritional status was assessed in a subset of patients (n = 11) using the Patient-Generated Subjective Global Assessment tool.
Seventy-five percent of patients lost weight throughout radiotherapy. Weight loss was significantly greater in patients experiencing unplanned radiotherapy breaks (-3.1% vs -1.6%, p < 0.05) and in patients not completing prescribed chemotherapy (-3.3% vs -1.6%, p < 0.05). Toxicity severity was strongly correlated with Patient-Generated Subjective Global Assessment score (rho = 0.839, p < 0.001) and was increased in patients experiencing unplanned admissions compared to those without admission (42.1% vs 9.3% with grade 3 toxicity respectively, p < 0.001).
Deterioration in nutritional status during radiotherapy (as measured by weight loss) may be associated with poorer short-term treatment outcomes in gastrointestinal cancer patients. Patient numbers were too small to definitively determine the effect of nutritional status at radiotherapy commencement or changes in nutritional status throughout radiotherapy (defined by PG-SGA) on treatment outcomes. Further research is required to investigate this in larger, longer-term studies.
胃肠道癌症患者易发生营养恶化，而放射治疗的毒性可能会使其恶化。本研究旨在确定胃肠道癌症患者放射治疗开始时的营养状况或放射治疗过程中营养状况的变化是否与治疗毒性和结局相关。
73 例接受根治性放射治疗的胃肠道癌症患者接受了病历审核，评估体重、放射治疗毒性、计划外治疗中断或住院以及完成规定治疗/疗程的情况。在一部分患者（n=11）中使用患者生成的主观整体评估工具评估营养状况。
75%的患者在放射治疗过程中体重减轻。计划外放射治疗中断的患者体重减轻更为明显（-3.1%比-1.6%，p<0.05），未完成规定化疗的患者体重减轻更为明显（-3.3%比-1.6%，p<0.05）。毒性严重程度与患者生成的主观整体评估评分高度相关（rho=0.839，p<0.001），与未住院的患者相比，计划住院的患者毒性更严重（分别为 42.1%和 9.3%的 3 级毒性，p<0.001）。
放射治疗期间（通过体重减轻来衡量）营养状况的恶化可能与胃肠道癌症患者短期治疗结局较差相关。患者数量太少，无法明确放射治疗开始时的营养状况或放射治疗过程中（由 PG-SGA 定义）营养状况的变化对治疗结局的影响。需要进一步的研究来在更大、更长期的研究中调查这一点。
