Effect Of Nutrition Intervention On Patients With Esophageal Cancer Undergoing Concurrent Chemoradiotherapy

Objective Esophageal cancer patients often have difficulty eating,so their nutritional status is poor.Nutrition has a greater impact on patients with esophageal cancer undergoing concurrent chemoradiotherapy.Therefore,we conducted a nutrition intervention study on patients with esophageal cancer undergoing concurrent chemoradiotherapy to determine whether nutritional status has an impact on the set-up errors and short-term effects of radiotherapy patients.Methods Enrollment criteria:pathologically confirmed patients with newly diagnosed esophageal cancer,patients with complete information,nutritional assessment records,setup error records,and patients receiving radical concurrent chemoradiotherapy with esophageal cancer were divided into the study group and the control group according to whether they received nutrition intervention.After screening,65 patients were included,including 35 in the study group and 30 in the control group.All patients were admitted to the European Nutritional Risk Screening Tool(NRS-2002)for nutrition assessment and risk screening at admission.Patients in the study group were actively given nutrition intervention based on the NRS score at the time of admission,and received concurrent chemoradiotherapy.Patients in the control group received NRS nutritional screening and then received concurrent radiochemotherapy only.Body weight,albumin(Alb),lymphocytes(LYM)were collected,and nutritional prognosis index(PNI)was calculated to assess the difference of nutritional status between the two groups.Setup error data during radiotherapy were recorded,and the Offset correction scalar(OCS)were calculated to compare the difference in setup error between the two groups of patients during the treatment.The correlation between the change in body weight and OCS were analyzed,and finally the difference of the short-term efficacy between the two groups was compared by the Mann-Whitney rank sum test.Results(1)The initial average weight of the study group was(63.591±0.71)kg,and the average weight of the control group was(63.95±0.6987)kg,and there was no significant difference in the initial average weight of the two groups(t=-0.6;P=0.5492).With the concurrent chemoradiotherapy,the weight of the study group remained constant,but the weight of the control group continued to decrease.At the end of radiotherapy,the average weight of patients in the study group was(63.92±0.67)kg;while the average weight of patients in the control group was(59.94±0.71)kg,and the difference was statistically significant(t=-4.05;P=0.0001).The mixed effect model analysis showed that the effect of nutrition intervention on body weight was statistically significant(χ~2=8.12;P=0.0059);and the measurement time was also an important factor affecting body weight(χ~2=8.74;P<0.0001).Interaction between nutrition intervention and measurement time points on body weight was statistically significant(χ~2=14.80;P<0.0001).(2)The average PNI score at the initial measurement time point of the study group was(54.294±0.723),which was slightly lower than that of the control group(55.123±0.781).However,due to the effects of nutritional intervention and time effect,the average PNI score of the study group at the final measurement time point was(52.074±0.723),which was significantly higher than that in the control group(48.893±0.781).The mixed effect model analysis showed that the effect of nutrition intervention on PNI was statistically significant(χ~2=5.83;P=0.0165);Similarly,the measurement time point was also an important factor affecting PNI(χ2=16.33;P<0.0001),and PNI was also affected by interaction between nutrition intervention and measurement time points(χ~2=4.31;P=0.0055).(3)The average value of OCS at the initial measurement time point of the study group was(0.394±0.020),which was slightly lower than that of the control group(0.429±0.018);however,the average value of OCS at the final measurement time point of the study group was(0.483±0.021),which was significantly lower than that of the control group(0.871±0.027).The mixed effect model analysis showed that the effect of nutrition intervention on OCS was statistically significant(χ~2=308.16;P<0.0001).Similarly,the measurement time point is also an important factor affecting OCS(χ~2=100.79;P<0.0001),and it was also affected by the interaction(χ~2=49.59;P=0.0055).(4)Among all the time points of repeated measurement,a total of 89 time points have both a weight change value and an offset correction scalar.Pearson correlation analysis showed that the correlation coefficient between OCS and weight change values at two adjacent time points was 0.282,95%CI(0.079,0.463),and P=0.007,which showed that a positive correlation existed.(5)There were no cases of progressive disease(PD)after chemotherapy in both groups.The short-term efficacy(CR,PR,SD)cases in the study group were 21,9,and 5 cases,and the control group was 11,12,and 7 cases.Therefore,the disease remission rate(CR+PR)of the two groups was 85.71%and 76.67%,and the Mann-Whitney rank-sum test showed that the difference was statistically significant(u=1.772,P=0.038).Conclusions(1)Nutrition intervention can effectively reduce the weight loss of patients,improve PNI,and improve the nutritional status of patientswith esophageal cancer undergoing concurrent radiotherapy.(2)Nutrition intervention can reduce the setup error during radiotherapy,improve the repeatability of radiotherapy setup,and improve the accuracy of radiotherapy.(3)For patients with esophageal cancer undergoing concurrent radiotherapy,weight loss is an important factor affecting setup error.There was a positive correlation between weight loss and setup error.The more weight loss,the more setup error was detected.In order to avoid local control rate drop caused by setup error,CBCT verification should be given every week.(4)Nutrition intervention can improve the short-term efficacy of patients with esophageal cancer undergoing concurrent radiotherapy.However,due to lack of follow-up data,further prospective studies are needed to explore the impact of nutrition intervention on the survival of patients with esophageal cancer undergoing concurrent radiotherapy.