| Objective: To explore the effect of the whole course individualized enteral nutrition support treatment during neoadjuvant chemoradiotherapy to preoperative period on the nutritional status and quality of life for Siewert type Ⅱ and Ⅲ local advanced adenocarcinoma of the esophagogastric junction patients as well as its effect on the adverse effects of neoadjuvant chemoradiotherapy therapy,short-term efficacy,providing references for clinical research.Methods: Cases of local advanced adenocarcinoma of the esophagogastric junction(NCT01962246)who were admitted to the Third Department of Surgery of the Fourth Hospital of Hebei Medical University from February 2012 to December 2018 were selected.All patients were of Siewert type Ⅱ and Ⅲ and received preoperative neoadjuvant chemoradiotherapy.Patients who meet the criteria for entry were randomly divided into the research group and the control group: In the control group,during neoadjuvant chemoradiotherapy to preoperative period,nutritionists will conduct nutrition education,nutrition evaluation and dietary recommendations,etc.On this basis,in the experimental group,nutritionists will formulates and implements an individualized enteral nutrition support program.The main observation indicators were the nutritional status and quality of life during the neoadjuvant chemoradiotherapy period and the preoperative interval.The nutritional status was evaluated by weight,laboratory indicators and the patient-generated subjective global assessment(PG-SGA),and the quality of life was assessed by quality of questionnaire of stomach 22(QLQ-STO22).The secondary observation indicators were the incidence of adverse reactions after neoadjuvant chemoradiotherapy,the therapeutic effect(the imaging efficacy,the pathological response rate,the radical surgery degree)of the two groups of patients.Results:1.Ninety enrolled cases were divided into two groups(n = 45).There was no significant difference in general clinical characteristics between both groups at the first diagnosis(P > 0.05).2.At the end of the neoadjuvant chemoradiotherapy,the decline in body weight,albumin,prealbumin,total protein,hemoglobin,and lymphocyte counts of the two groups reached the maximum,and they increased during the preoperative interval.The decrease in body weight,albumin,prealbumin,total protein,and hemoglobin of the research group was lower(P < 0.05),but difference did not reach significance in reduced lymphocyte counts between the two groups of patients(P > 0.05).3.The PG-SGA scores of the research group and the control group at the first diagnosis were(3.08±1.20)and(3.20±1.67),respectively.At the end of neoadjuvant chemoradiotherapy,the two groups had the highest PG-SGA scores,and the research group had excellent scores(6.33±1.41)compared with the control group(7.44±1.69)(P < 0.05).The PG-SGA scores of the two groups of patients decreased during the preoperative interval,and the score of the reserach group(3.31±1.75)as still lower than that of the control group(6.02±1.53)(P < 0.05).4.The QLQ-STO22 scores of the research group and the control group at the first diagnosis were(11.97±4.66)and(11.49±4.85),respectively.The same trend was observed in QLQ-STO22 score and PG-SGA score between the two groups.At the end of neoadjuvant chemoradiotherapy,the QLQ-STO22 score of the two groups of patients reached the maximum,and the score of the research group(16.46±5.47)was higher than control group(21.16±5.52)(P <0.05).The QLQ-STO22 scores of both groups decreased during the preoperative interval,and the scores of the experimental group(12.30±5.21)were still lower than those of the control group(14.83±5.06)(P < 0.05).5.Administration of the whole course individualized enteral nutrition decreased the incidence of the hematological adverse reactions,including decreased leukopenia,decreased neutropenia,and anemia in the research group,compared to control group(P < 0.05).The incidence of non-hematological adverse reactions,including nausea and loss of appetite in was the experimental group lower as well(P < 0.05).The incidence of radiation stomach/esophagitis and radiation pneumonia was also decreased(P> 0.05).6.Two patients in the control group did not undergo surgery due to peritoneal metastases.Research group had lower objective response rate,pathologic complete response,pathological total remission rate,and R0 resection rate(P > 0.05).Conclusions:1.The whole course individualized enteral nutrition support treatment during the period of neoadjuvant chemoradiotherapy and the preoperative interval had a positive effect on improving the nutritional status and quality of life of patients.2.The whole course individualized enteral nutrition support treatment could reduce the toxicity of neoadjuvant chemoradiotherapy.3.The whole course individualized enteral nutrition support treatment may improve the effectiveness of neoadjuvant chemoradiotherapy which needs further research to confirm. |
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