PARENTERAL-NUTRITION IN CANCER-PATIENTS RECEIVING CHEMOTHERAPY - EFFECTS ON TOXICITY AND NUTRITIONAL-STATUS

The role of total parenteral nutrition (TPN) in reducing toxicity rela ted to cancer chemotherapy (CT) is presently a controversial issue. To evaluate the effectiveness of TPN in reducing CT-associated toxicity and correcting and preventing CT-related impairments of nutritional st atus, a prospective crossover controlled study was performed in 43 can cer patients (19 normally nourished and 24 malnourished) randomly divi ded into two groups (A and B). Group A patients received TPN concomita ntly with the first course of chemotherapy, and the second course was administered 21 to 28 days later without TPN support; group B patients were treated in the opposite sequence. The rates of myelotoxicities a nd gastrointestinal toxicities after CT courses with or without TPN we re essentially similar in normally nourished and malnourished patients . No changes in nutritional indexes were detected in normally nourishe d subjects after each course. Conversely, in undernourished subjects, prealbumin, retinol-binding protein, and nitrogen balance increased in CT + TPN courses (p < .02). In CT-only courses, undernourished subjec ts showed a decrease in prealbumin and nitrogen balance. Significant c hanges of nitrogen balance in CT vs CT + TPN courses were detected in malnourished subjects. TPN appears to be unable to reduce CT-associate d toxicity. CT administration does not result in any impairment of the nutritional status in normally nourished cancer patients. From our st udy, it appears that TPN should be limited to severely malnourished ne oplastic patients undergoing CT, because of its ability to prevent fur ther impairment of nutritional status and to improve the nitrogen bala nce and the levels of fast-turnover visceral proteins.