We use cookies to improve your experience. By continuing to browse this site, you accept our cookie policy.×
Skip main navigation
Aging Health
Bioelectronics in Medicine
Biomarkers in Medicine
Breast Cancer Management
CNS Oncology
Colorectal Cancer
Concussion
Epigenomics
Future Cardiology
Future Medicine AI
Future Microbiology
Future Neurology
Future Oncology
Future Rare Diseases
Future Virology
Hepatic Oncology
HIV Therapy
Immunotherapy
International Journal of Endocrine Oncology
International Journal of Hematologic Oncology
Journal of 3D Printing in Medicine
Lung Cancer Management
Melanoma Management
Nanomedicine
Neurodegenerative Disease Management
Pain Management
Pediatric Health
Personalized Medicine
Pharmacogenomics
Regenerative Medicine

Enteral nutritional support in patients undergoing chemoradiotherapy for esophageal carcinoma

    Bei Wang

    Department of Radiotherapy Oncology, The Affiliated Yancheng First Hospital of Nanjing University Medical School, The First people’s Hospital of Yancheng, 66 South People's Road, Yancheng, 224000, Jiangsu Province, PR China

    ,
    Xiaowen Jiang

    Department of Radiotherapy Oncology, The Affiliated Yancheng First Hospital of Nanjing University Medical School, The First people’s Hospital of Yancheng, 66 South People's Road, Yancheng, 224000, Jiangsu Province, PR China

    ,
    Dalong Tian

    Department of Radiotherapy Oncology, The Affiliated Yancheng First Hospital of Nanjing University Medical School, The First people’s Hospital of Yancheng, 66 South People's Road, Yancheng, 224000, Jiangsu Province, PR China

    &
    Wei Geng

    *Author for correspondence:

    E-mail Address: weihuo2001@163.com

    Department of Radiotherapy Oncology, The Affiliated Yancheng First Hospital of Nanjing University Medical School, The First people’s Hospital of Yancheng, 66 South People's Road, Yancheng, 224000, Jiangsu Province, PR China

    Published Online:https://doi.org/10.2217/fon-2020-0181

    Esophageal cancer patients are at a high risk of malnutrition. Both the disease itself and chemoradiotherapy will lead to the deterioration of nutritional status. The development of nutritional oncology promotes the application of enteral nutrition in tumor patients. Through nutritional support, prognosis is improved and the incidence of adverse chemoradiotherapy reactions is reduced, especially in those with head and neck or esophageal cancer. This review summarizes enteral nutritional support in esophageal cancer patients undergoing chemoradiotherapy in recent years, including a selection of nutritional assessment tools, the causes and consequences of malnutrition in esophageal cancer patients, types of access and effects of enteral nutrition. More patients with esophageal cancer will benefit from the development of enteral nutrition technology in the future.

    Papers of special note have been highlighted as: • of interest; •• of considerable interest

    References

    • 1. Chen W, Zheng R, Baade PD et al. Cancer statistics in China, 2015. CA Cancer J. Clin. 66(2), 115–132 (2016).
    • 2. Ma L, Luo GY, Ren YF et al. Concurrent chemoradiotherapy combined with enteral nutrition support: a radical treatment strategy for esophageal squamous cell carcinoma patients with malignant fistulae. Chin. J. Cancer 36(1), 8 (2017).
    • 3. Mak M, Bell K, Ng W, Lee M. Nutritional status, management and clinical outcomes in patients with esophageal and gastro-oesophageal cancers: a descriptive study. Nutr. Diet. 74(3), 229–235 (2017).
    • 4. Hebuterne X, Lemarie E, Michallet M, de Montreuil CB, Schneider SM, Goldwasser F. Prevalence of malnutrition and current use of nutrition support in patients with cancer. JPEN J. Parenter. Enteral Nutr. 38(2), 196–204 (2014).
    • 5. Arends J, Bodoky G, Bozzetti F et al. ESPEN guidelines on enteral nutrition: non-surgical oncology. Clin. Nutr. 25(2), 245–259 (2006). • Specifically elucidated enteral nutrition in patients with head and neck or esophageal cancer and mentioned the indications and goals of enteral nutrition.
    • 6. Lyu J, Li T, Xie C et al. Enteral nutrition in esophageal cancer patients treated with radiotherapy: a Chinese expert consensus 2018. Future Oncol. 15(5), 517–531 (2019). •• First Chinese expert consensus of enteral nutrition in esophageal cancer patients treated with radiotherapy, which has important guiding significance.
    • 7. Isenring E, Bauer J, Capra S. The scored Patient-Generated Subjective Global Assessment (PG-SGA) and its association with quality of life in ambulatory patients receiving radiotherapy. Eur. J. Clin. Nutr. 57(2), 305–309 (2003).
    • 8. Jager-Wittenaar H, Ottery FD. Assessing nutritional status in cancer: role of the Patient-Generated Subjective Global Assessment. Curr. Opin. Clin. Nutr. Metab. Care 20(5), 322–329 (2017).
    • 9. Vigano AL, di Tomasso J, Kilgour RD et al. The abridged Patient-Generated Subjective Global Assessment is a useful tool for early detection and characterization of cancer cachexia. J. Acad. Nutr. Diet 114(7), 1088–1098 (2014).
    • 10. Kim JY, Wie GA, Cho YA et al. Development and validation of a nutrition screening tool for hospitalized cancer patients. Clin. Nutr. 30(6), 724–729 (2011).
    • 11. Persson C, Sjoden PO, Glimelius B. The Swedish version of the Patient-Generated Subjective Global Assessment of nutritional status: gastrointestinal vs urological cancers. Clin. Nutr. 18(2), 71–77 (1999).
    • 12. Read JA, Crockett N, Volker DH et al. Nutritional assessment in cancer: comparing the Mini Nutritional Assessment (MNA) with the scored Patient-Generated Subjective Global Assessment (PG-SGA). Nutr. Cancer 53(1), 51–56 (2005).
    • 13. Bauer JM, Vogl T, Wicklein S, Trögner J, Mühlberg W, Sieber CC. Comparison of the Mini Nutritional Assessment, Subjective Global Assessment, and Nutritional Risk Screening (NRS 2002) for nutritional screening and assessment in geriatric hospital patients. Z. Gerontol. Geriatr. 38(5), 322–327 (2005).
    • 14. Ye XJ, Ji YB, Ma BW et al. Comparison of three common nutritional screening tools with the new European Society for Clinical Nutrition and Metabolism (ESPEN) criteria for malnutrition among patients with geriatric gastrointestinal cancer: a prospective study in China. BMJ Open 8(4), e019750 (2018).
    • 15. Almeida AI, Correia M, Camilo M, Ravasco P. Nutritional risk screening in surgery: valid, feasible, easy! Clin. Nutr. 31(2), 206–211 (2012).
    • 16. Ryu SW, Kim IH. Comparison of different nutritional assessments in detecting malnutrition among gastric cancer patients. World J. Gastroenterol. 16(26), 3310–3317 (2010).
    • 17. Orell-Kotikangas H, Osterlund P, Saarilahti K, Ravasco P, Schwab U, Makitie AA. NRS-2002 for pre-treatment nutritional risk screening and nutritional status assessment in head and neck cancer patients. Support. Care Cancer 23(6), 1495–1502 (2015).
    • 18. Thoresen L, Fjeldstad I, Krogstad K, Kaasa S, Falkmer UG. Nutritional status of patients with advanced cancer: the value of using the subjective global assessment of nutritional status as a screening tool. Palliat Med. 16(1), 33–42 (2002).
    • 19. Gupta D, Lammersfeld CA, Vashi PG, Burrows J, Lis CG, Grutsch JF. Prognostic significance of Subjective Global Assessment (SGA) in advanced colorectal cancer. Eur. J. Clin. Nutr. 59(1), 35–40 (2005).
    • 20. Kwang AY, Kandiah M. Objective and subjective nutritional assessment of patients with cancer in palliative care. Am. J. Hosp. Palliat. Care 27(2), 117–126 (2010).
    • 21. Lloyd S, Chang BW. Current strategies in chemoradiation for esophageal cancer. J. Gastrointest. Oncol. 5(3), 156–165 (2014).
    • 22. Rietveld SCM, Witvliet-van Nierop JE, Ottens-Oussoren K, van der Peet DL, de van der Schueren MAE. The prediction of deterioration of nutritional status during chemoradiation therapy in patients with esophageal cancer. Nutr. Cancer. 70(2), 229–235 (2018).
    • 23. Qiu Y, You J, Wang K et al. Effect of whole-course nutrition management on patients with esophageal cancer undergoing concurrent chemoradiotherapy: a randomized control trial. Nutrition 69, 110558 (2020). • Different from previous studies, this compared the whole-course nutrition management of patients with general nutrition treatment of esophageal cancer undergoing concurrent chemoradiotherapy.
    • 24. Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin. Nutr. 22(3), 235–239 (2003).
    • 25. Arends J, Baracos V, Bertz H et al. ESPEN expert group recommendations for action against cancer-related malnutrition. Clin. Nutr. 36(5), 1187–1196 (2017).
    • 26. Mayanagi S, Tsubosa Y, Omae K et al. Negative impact of skeletal muscle wasting after neoadjuvant chemotherapy followed by surgery on survival for patients with thoracic esophageal cancer. Ann. Surg. Oncol. 24(12), 3741–3747 (2017).
    • 27. Reisinger KW, Bosmans JW, Uittenbogaart M et al. Loss of skeletal muscle mass during neoadjuvant chemoradiotherapy predicts postoperative mortality in esophageal cancer surgery. Ann. Surg. Oncol. 22(13), 4445–4452 (2015).
    • 28. Miller KR, Bozeman MC. Nutrition therapy issues in esophageal cancer. Curr. Gastroenterol. Rep. 14(4), 356–366 (2012).
    • 29. Evans JA, Early DS, Chandraskhara V et al. The role of endoscopy in the assessment and treatment of esophageal cancer. Gastrointest. Endosc. 77(3), 328–334 (2013).
    • 30. Spaander MC, Baron TH, Siersema PD et al. Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy 48(10), 939–948 (2016).
    • 31. Battersby NJ, Bonney GK, Subar D, Talbot L, Decadt B, Lynch N. Outcomes following oesophageal stent insertion for palliation of malignant strictures: a large single centre series. J. Surg. Oncol. 105(1), 60–65 (2012).
    • 32. Mao-de-Ferro S, Serrano M, Ferreira S et al. Stents in patients with esophageal cancer before chemoradiotherapy: high risk of complications and no impact on the nutritional status. Eur. J. Clin. Nutr. 70(3), 409–410 (2016).
    • 33. Lin CH, Liu NJ, Lee CS et al. Nasogastric feeding tube placement in patients with esophageal cancer: application of ultrathin transnasal endoscopy. Gastrointest. Endosc. 64(1), 104–107 (2006).
    • 34. Grilo A, Santos CA, Fonseca J. Percutaneous endoscopic gastrostomy for nutritional palliation of upper esophageal cancer unsuitable for esophageal stenting. Arq. Gastroenterol. 49(3), 227–231 (2012).
    • 35. Blomberg J, Lagergren J, Martin L, Mattsson F, Lagergren P. Complications after percutaneous endoscopic gastrostomy in a prospective study. Scand. J. Gastroenterol. 47(6), 737–742 (2012).
    • 36. Keung EZ, Liu X, Nuzhad A, Rabinowits G, Patel V. In-hospital and long-term outcomes after percutaneous endoscopic gastrostomy in patients with malignancy. J. Am. Coll. Surg. 215(6), 777–786 (2012).
    • 37. Kakuta T, Kosugi SI, Ichikawa H et al. Palliative interventions for patients with incurable locally advanced or metastatic thoracic esophageal carcinoma. Esophagus 16(3), 278–284 (2019). • Discusses palliative intervention for patients with advanced esophageal cancer, suggesting we should choose appropriate nutritional interventions based on patient situation.
    • 38. Yu FJ, Shih HY, Wu CY et al. Enteral nutrition and quality of life in patients undergoing chemoradiotherapy for esophageal carcinoma: a comparison of nasogastric tube, esophageal stent, and ostomy tube feeding. Gastrointest. Endosc. 88(1), 21–31 (2018). • Compared the effects of three enteral nutrition interventions and their advantages and disadvantages.
    • 39. Sofue K, Takeuchi Y, Tsurusaki M et al. Value of percutaneous radiologic gastrostomy for patients with advanced esophageal cancer. Ann. Surg. Oncol. 23(11), 3623–3631 (2016).
    • 40. Jiang XY, Bertrand AS, Li G et al. CT-guided percutaneous gastrostomy without preliminary placement of a nasogastric tube. J. Vasc. Interv. Radiol. 30(6), 915–917 (2019).
    • 41. Min YW, Jang EY, Jung JH et al. Comparison between gastrostomy feeding and self-expandable metal stent insertion for patients with esophageal cancer and dysphagia. PLoS One 12(6), e0179522 (2017).
    • 42. Prado CM, Baracos VE, McCargar LJ et al. Body composition as an independent determinant of 5-fluorouracil-based chemotherapy toxicity. Clin. Cancer Res. 13(11), 3264–3268 (2007).
    • 43. Gupta D, Lis CG. Pretreatment serum albumin as a predictor of cancer survival: a systematic review of the epidemiological literature. Nutr. J. 9, 69 (2010).
    • 44. Cederholm T, Bosaeus I, Barazzoni R et al. Diagnostic criteria for malnutrition – an ESPEN consensus statement. Clin. Nutr. 34(3), 335–340 (2015).
    • 45. Cox S, Powell C, Carter B, Hurt C, Mukherjee S, Crosby TD. Role of nutritional status and intervention in oesophageal cancer treated with definitive chemoradiotherapy: outcomes from SCOPE1. Br. J. Cancer 115(2), 172–177 (2016).
    • 46. Yokota T, Ando N, Igaki H et al. Prognostic factors in patients receiving neoadjuvant 5-fluorouracil plus cisplatin for advanced esophageal cancer (JCOG9907). Oncology 89(3), 143–151 (2015).
    • 47. Gibbs J, Cull W, Henderson W et al. Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch. Surg. 134(1), 36–42 (1999).
    • 48. Jiang N, Zhao JZ, Chen XC et al. Clinical determinants of weight loss in patients with esophageal carcinoma during radiotherapy: a prospective longitudinal view. Asian Pac. J. Cancer Prev. 15(5), 1943–1948 (2014).
    • 49. Li B, Lu Z, Wang S et al. Pretreatment elevated prognostic nutritional index predicts a favorable prognosis in patients with prostate cancer. BMC Cancer 20(1), 361 (2020).
    • 50. Xia LJ, Li W, Zhai JC et al. Significance of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio and prognostic nutritional index for predicting clinical outcomes in T1–2 rectal cancer. BMC Cancer 20(1), 208 (2020).
    • 51. Akgül Ö, Çetinkaya E, Yalaza M et al. Prognostic efficacy of inflammation-based markers in patients with curative colorectal cancer resection. World J. Gastrointest. Oncol. 9(7), 300–307 (2017).
    • 52. Gaurav K, Goel RK, Shukla M, Pandey M. Glutamine: a novel approach to chemotherapy-induced toxicity. Indian J. Med. Paediatr. Oncol. 33(1), 13–20 (2012).
    • 53. Sun ZW, Jia J, Yang Y et al. Enteral nutrition support reduces toxicity of chemotherapy in patients with advanced or metastatic esophageal cancer. Beijing Da Xue Xue Bao Yi Xue Ban. 52(2), 261–268 (2020).
    • 54. Cong MH, Li SL, Cheng GW et al. An interdisciplinary nutrition support team improves clinical and hospitalized outcomes of esophageal cancer patients with concurrent chemoradiotherapy. Chin. Med. J. 128(22), 3003–3007 (2015).
    • 55. Buntzel J, Krauss T, Buntzel H et al. Nutritional parameters for patients with head and neck cancer. Anticancer Res. 32(5), 2119–2123 (2012).