Nutritional support in patients with cancer of the esophagus: Impact on nutritional status, patient compliance to therapy, and survival

Alms and background: The multimodal approach to patients with esophageal sq uamous cell carcinoma often includes polychemotherapy combined with radiati on therapy, Cancer dysphagia and drug-related anorexia, mucositis and vomit ing can all lead to malnutrition, The aim of this study was to analyze the impact of the administration of enteral nutrition (EN) on the patient's nut ritional status, tolerance of chemotherapy and radiotherapy, and final onco logical outcome. Methods: Fifty esophageal cancer patients who were to be s ubmitted to chemotherapy (days 1-4 5-fluorouracil (FU) 1 g/m(2)/day and cis platin (CDDP) 100 mg/m(2)/day 1)for two cycles plus radiotherapy (31 Gy) we re referred to the Nutrition Support Unit prior to any therapy due to their malnourished status. Twenty-nine dysphagic patients received nutrition via tube (37 kcal/kg/day + 2.0 g proteins/kg/day for 34 days), while 21 others who were not dysphagic were given a standard oral diet (SD). The patients who received EN had a more severe weight loss than the SD patients (16.8% v s 12.8%, P < 0.02). Results: The dose of administered EN represented 86% of the planned support, and 70% of the nutritional therapy was administered i n the home setting. Administration of EN support resulted in stable body we ight and unchanged levels of visceral proteins, while SD patients had a dec rease in body weight, total proteins and serum albumin (P < 0.01). There wa s no difference between the two groups in terms of tolerance and response t o cancer therapy, suitability for radical resection and median survival (9. 5 months). Conclusions: EN in patients with cancer of the esophagus undergo ing chemotherapy and radiotherapy is well tolerated, feasible even in the h ome setting, prevents further nutritional deterioration and achieves the sa me oncological results in dysphagic patients as those achieved in non-dysph agic patients.