Salas-Salas Bárbara Gabriela, Ferrera-Alayón Laura, Calleja-Fernández Alicia, Chicas-Sett Rodolfo, Nogués-Ramia Eva, Zafra-Martín Juan, Lloret Marta
Department of Radiation Oncology, University Hospital of Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain.
University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
Front Nutr. 2024 Dec 20;11:1414367. doi: 10.3389/fnut.2024.1414367. eCollection 2024.
Patients with rectal cancer may develop gastrointestinal toxicity associated with chemo-radiotherapeutic treatment that conditions their clinical, functional, and nutritional evolution. The aim of the study was to evaluate the efficacy of nutritional supplementation with a glutamine-enriched peptide diet (PD) compared to exclusive dietary advice (DA) on gastrointestinal toxicity, interruption of oncologic treatment, and nutritional evolution in patients with rectal cancer undergoing neoadjuvant treatment.
Prospective cohort study with two groups. Patients with rectal cancer in treatment with neoadjuvant chemo-radiotherapy were recruited. One group of patients received nutritional supplementation with PD, and another group received DA exclusively, from the beginning of radiotherapy until the time of surgery. Intestinal toxicity was evaluated with the CTCAE 5.0 scale, functionality with the ECOG scale and nutritional status with GLIM criteria.
Fifty-four patients were initially selected, although 51 were finally enrolled: 25 in the PD group and 26 in the DA group. There was a reduction in the risk of diarrhea in the PD group midway through radiotherapy treatment [RR of 0.218 (95% CI = 0.052-0.923)] and at the end of treatment [RR of 0.103 (95% CI = 0.020-0.537)], as well as a reduction in the risk of developing mucositis at the end of treatment [RR of 0.405 (95% CI = 0.280-0.584)]. The use of a PD also decreased treatment interruptions with radiotherapy in stage III patients (0 vs. 15.8%, = 0.049) and in malnourished patients (0 vs. 18.2%, = 0.040).
The glutamine-enriched peptide diet had a protective effect on the development of diarrhea and mucositis associated with chemo-radiotherapeutic treatment in patients with colorectal cancer under neoadjuvant treatment, as well as the interruption of radiotherapeutic treatment.
直肠癌患者在接受放化疗时可能会出现胃肠道毒性，这会影响他们的临床、功能和营养状况。本研究的目的是评估与单纯饮食建议（DA）相比，富含谷氨酰胺的肽类饮食（PD）营养补充对接受新辅助治疗的直肠癌患者胃肠道毒性、肿瘤治疗中断及营养状况的影响。
前瞻性队列研究，分为两组。招募接受新辅助放化疗的直肠癌患者。一组患者从放疗开始至手术时接受PD营养补充，另一组仅接受DA。采用CTCAE 5.0量表评估肠道毒性，ECOG量表评估功能状态，GLIM标准评估营养状况。
最初筛选了54例患者，最终纳入51例：PD组25例，DA组26例。放疗中期，PD组腹泻风险降低[相对风险（RR）为0.218，95%置信区间（CI）=0.052-0.923]，治疗结束时腹泻风险也降低[RR为0.103，95%CI=0.020-0.537]，治疗结束时发生黏膜炎的风险也降低[RR为0.405，95%CI=0.280-0.584]。PD的使用还减少了III期患者（0%对15.8%，P=0.049）和营养不良患者（0%对18.2%，P=0.040）放疗中断的情况。
富含谷氨酰胺的肽类饮食对接受新辅助治疗的结直肠癌患者放化疗相关的腹泻和黏膜炎的发生以及放疗中断具有保护作用。
