Meng Lingbin, Wei Jinlong, Ji Rui, Wang Bin, Xu Xiaochun, Xin Ying, Jiang Xin
Department of Radiation Oncology, the First Hospital of Jilin University, Changchun, China.
Department of Internal Medicine, Florida Hospital, Orlando, FL 32804, USA.
J Cancer. 2019 Jun 9;10(16):3650-3656. doi: 10.7150/jca.33475. eCollection 2019.
: Patients with nasopharyngeal carcinoma (NPC) frequently developed the problem of malnutrition at the time of diagnosis. Chemoradiotherapy (CRT) can even worsen the situation. Therefore, nutritional intervention should be applied to prevent CRT-associated weight loss and interruption of CRT. However, it is still controversial if early nutritional intervention is beneficial to NPC patients with CRT. This study is to investigate the influence of early nutritional intervention on advanced NPC patients with CRT by evaluating the nutritional status and CRT treatment tolerance. : A cohort of 78 stage III-IV nasopharyngeal carcinoma patients was divided into early (n=46) and late (n=32) nutrition intervention groups. The early group of patients received nutritional support at the beginning of CRT, whereas the late group received such a support until development of the side effects, like 50% required oral dietary intake or >10% weight loss. The data were collected and statistically analyzed. : There was no significant difference in baseline clinical characteristics between these two groups, suggesting that no selection bias occurred. Both groups of patients had weight loss at the end of CRT and 3 months thereafter. However, at the later time point, the early group started to regain their weight, while the late group continued to lose weight. At both time points, the early group had a lower percentage of weight loss than the late group. Similar results were also obtained for BMI, albumin, and pre-albumin levels (All <0.05). Besides, the early group showed a lower rate of advanced mucositis, a lower percentage of patients with more than 3 days RT breaks, fewer days of RT delayed for toxicity, and a lower percentage of patients with unplanned hospitalizations (All <0.05). A linear correlation was also found between the percentage of weight loss and the number of days of RT delayed. : Early nutritional intervention provides beneficial outcomes to NPC patients by maintaining their nutritional status and enhancing CRT treatment tolerance. Our results also indicated early nutrition intervention may reduce the hospital cost and improve patients' life quality.
鼻咽癌（NPC）患者在确诊时经常出现营养不良问题。放化疗（CRT）甚至会使情况恶化。因此，应进行营养干预以预防与放化疗相关的体重减轻和放化疗中断。然而，早期营养干预对接受放化疗的鼻咽癌患者是否有益仍存在争议。本研究旨在通过评估营养状况和放化疗治疗耐受性，探讨早期营养干预对晚期鼻咽癌患者放化疗的影响。
将78例III-IV期鼻咽癌患者分为早期（n = 46）和晚期（n = 32）营养干预组。早期组患者在放化疗开始时接受营养支持，而晚期组患者直到出现副作用，如50%需要口服饮食摄入或体重减轻>10%时才接受营养支持。收集数据并进行统计分析。
两组患者的基线临床特征无显著差异，表明未发生选择偏倚。两组患者在放化疗结束时及之后3个月均出现体重减轻。然而，在后期时间点，早期组开始恢复体重，而晚期组继续体重减轻。在两个时间点，早期组的体重减轻百分比均低于晚期组。体重指数、白蛋白和前白蛋白水平也得到了类似结果（均P<0.05）。此外，早期组的重度黏膜炎发生率较低，放疗中断超过3天的患者百分比较低，因毒性导致的放疗延迟天数较少，非计划住院患者百分比较低（均P<0.05）。体重减轻百分比与放疗延迟天数之间也发现了线性相关性。
早期营养干预通过维持鼻咽癌患者的营养状况和提高放化疗治疗耐受性，为患者带来有益结果。我们的结果还表明，早期营养干预可能降低住院费用并提高患者生活质量。
