ROLE OF NUTRITION SUPPORT DURING INDUCTION CHEMORADIATION THERAPY IN ESOPHAGEAL CANCER

Background: Preoperative chemoradiation therapy (CRT) potentially bene fits a subgroup of patients with esophageal cancer. The ability to adm inister aggressive CRT may depend on the initial nutritional status an d the ability to sustain nutrition during therapy. Parenteral nutritio n support during CRT may lead to complications that limit its usefulne ss and negate any potential benefit. Methods: Data were analyzed to ev aluate the role of parenteral nutrition support (PNS) in patients rece iving CRT. Forty-five consecutive patients with locoregional esophagea l cancer, enrolled in a phase I/II trial of induction CRT, were analyz ed. On the basis of the nutrition support received, two groups were de fined as follows: group I (with PNS, n = 30) and group II (without PNS , n = 15). Results were compared in terms of chemotherapy (CT) dose to lerated, morbidity of CRT, response rates, and surgical outcome in gro ups with and without PNS. Results: The two groups were comparable for demographic data, stage and site of disease, and performance status. T here was no significant difference between the groups in the nutrition al parameters (weight and serum albumin) before and after CRT. Group I patients received significantly more (% of total calculated dose) CT compared with group II (5-fluorouracil [5-FU], 86.4% vs 68.8%, p = .02 ; cisplatin [CDDP], 90.8% vs 78.2%, p = .05; and interferon alpha-2b [ IFN-alpha], 95.4% vs 79.8%, p = .05, in groups I and II, respectively) . Major (grade III/IV) adverse effects of CT were hematologic (group I , 93.3% vs group II, 86.6%, p = .59) and gastrointestinal (group I, 56 .67% vs group II, 33.3%, p = .2). Postsurgical staging revealed comple te response in 10 (22%) and a major response in 23 (51%) patients, alt hough the response rates were similar in the two groups (group I, 76.6 % vs group II, 66.6%, p = .8). Surgical morbidity (51.8% vs 61.5%, p = .73), mortality (7.4% vs 7.6%, p = 1.00), and hospital stay (22.5 vs 19.6 days, p = .63) were also similar in the two groups. Conclusions: PNS can be provided to these patients without an increased risk of CRT or resection-related morbidity. Although early and prolonged PNS faci litates administration of complete CRT doses, no benefit is derived fr om the administration of more CRT in the present regimen. The utility of PNS in this setting is unclear and, until further clarified, should not be applied routinely to this cohort of patients.