一种针对特定疾病的肠内营养配方可改善头颈部和食管癌放化疗患者的营养状况和功能表现：一项随机、对照、多中心试验的结果。

A disease-specific enteral nutrition formula improves nutritional status and functional performance in patients with head and neck and esophageal cancer undergoing chemoradiotherapy: results of a randomized, controlled, multicenter trial.

机构信息

Department of Radiation Oncology, Erlangen University Hospital, Erlangen, Germany.

出版信息

Cancer. 2013 Sep 15;119(18):3343-53. doi: 10.1002/cncr.28197. Epub 2013 Jun 13.

DOI:10.1002/cncr.28197

PMID:23765693

Abstract

BACKGROUND

In patients with head and neck and esophageal tumors, nutritional status may deteriorate during concurrent chemoradiotherapy (CRT). The aim of this study was to investigate the influence of enteral nutrition enriched with eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) on body composition and nutritional and functional status.

METHODS

In a controlled, randomized, prospective, double-blind, multicenter study, 111 patients with head and neck and esophageal cancer undergoing concurrent CRT received either an enteral standard nutrition (control group) or disease-specific enteral nutrition Supportan®-containing EPA+DHA (experimental group) via percutaneous endoscopic gastrostomy. The primary endpoint was the change of body cell mass (BCM) following CRT at weeks 7 and 14 compared with the baseline value. Secondary endpoints were additional parameters of body composition, anthropometric parameters, and nutritional and functional status.

RESULTS

The primary endpoint of the study, improvement in BCM, reached borderline statistical significance. Following CRT, patients with experimental nutrition lost only 0.82 ± 0.64 kg of BCM compared with 2.82 ± 0.77 kg in the control group (P = .055). The objectively measured nutritional parameters, such as body weight and fat-free mass, showed a tendency toward improvement, but the differences were not significant. The subjective parameters, in particular the Kondrup score (P = .0165) and the subjective global assessment score (P = .0065) after follow-up improved significantly in the experimental group, compared with the control group. Both enteral regimens were safe and well tolerated.

CONCLUSION

Enteral nutrition with EPA and DHA may be advantageous in patients with head and neck or esophageal cancer by improving parameters of nutritional and functional status during CRT.

摘要

背景

在头颈部和食管肿瘤患者中，同期放化疗（CRT）期间营养状况可能会恶化。本研究旨在探讨富含二十碳五烯酸（EPA）和二十二碳六烯酸（DHA）的肠内营养对身体成分以及营养和功能状态的影响。

方法

在一项对照、随机、前瞻性、双盲、多中心研究中，111 例头颈部和食管癌症患者接受同期 CRT，经皮内镜胃造口术给予肠内标准营养（对照组）或含有 EPA+DHA 的专用肠内营养 Supportan®（实验组）。主要终点是 CRT 后第 7 周和第 14 周与基线值相比的细胞内液量（BCM）变化。次要终点是身体成分的其他参数、人体测量参数以及营养和功能状态。

结果

研究的主要终点，BCM 的改善达到了边缘统计学意义。在 CRT 后，实验组患者仅丢失 0.82 ± 0.64kg 的 BCM，而对照组丢失 2.82 ± 0.77kg（P=0.055）。客观测量的营养参数，如体重和去脂体重，显示出改善的趋势，但差异无统计学意义。主观参数，特别是 Kondrup 评分（P=0.0165）和主观整体评估评分（P=0.0065）在随访后实验组显著改善，与对照组相比。两种肠内方案均安全且耐受良好。