The Investigation And Analysis Of Nutritional Support In Patients With Nasopharyngeal Carcinoma During Radiotherapy

Object:Radiotherapy is the top preferred treatment for nasopharyngeal carcinoma.It can effectively kill tumor cell,so as to improve the local control rate of tumor greatly.But at the same time,concurrent radio chemotherapy increases the incidence of the side effects,especially in aspects of malnutrition and nutritional risk.Furthermore,nutritional risk increases the toxicities of radio chemotherapy which would cease the therapeutic process and indicate poor prognosis.In this investment,meta analysis and clinical date analysis were carried out to investigate the importance of nutritional support in alleviating acute response of radiation therapy and improving survival and therapeutic effect in patients with nasopharyngeal carcinoma during radiotherapy.In this way,evidences would be provided to help make clinical therapeutic and nutrition intervention strategies.Metheods and results of this investment are included below.Part 1: Systematic review and meta analysis were carried out about the influence of nutritional support on nutritional indexes and side effect rate in patients with nasopharyngeal carcinoma.82 articles including Chinese and English languages were originally selected.After further screen with including and excluding criterias,17 articles were finally included.Meta analysis were conducted in fixed effect model and random effect model.Results showed that nutritional support have beneficial effects on clinical outcomes even though not by directly anti-cancer or eliminating tumor cells.Statistic significance differences were found in nasopharyngeal carcinoma patients of nutritional support compeering to the control group in the thickness of triceps brachii skin wrinkle[MD=1.741,95%CI(1.287,2.194),Z=7.53,P<0.001],body mass[MD=5.647,95%CI(4.505,6.789),Z=9.69,P<0.001],hemoglobin[MD=1.741,95%CI(0.901,2.582),Z=4.06,P<0.001],serum albumin[MD=3.762,95%CI(1.324,6.199),Z=3.02,P=0.002],and incidence rate of nutritional risk[RR=0.493,95%CI(0.246,0.987),Z=2.42,P=0.015].Part 2: Retrospective analysis of nutritional support in patients with nasopharyngeal carcinoma during radiotherapy.Date were collected from 346 patients in our department between May,2003 and May,2015.All the patients were diagnosed of squamous cell carcinoma by nasopharyngeal examination and biopsy pathology.All the patients received radical radiotherapy.Patients were divided into 2 groups according to whether nutritional support was performed.Recent effects and total survival results in different nutritional support methods were compared.Results showed that the BMI,nutrition indexes(Serum albumin,hemoglobin and platelet),adverse reactions(painful swallowing pain and bone marrow suppression),KPS scores in nutritional support group were better than those in the control group.The survival rate of intervention group was higher than that of control group.Conclusions:For the nutrition intervention group who received enteral nutrition support,their nutritional indicators significantly decreased less,their compliance and tolerance of radiotherapy and chemotherapy were improved,the incidence of grade Ⅲ-Ⅳ adverse reactions decreased significantly,and they had longer survival time.Therefore,I recommended patients with nasopharyngeal carcinoma to receive whole-course nutritional support treatment during radiochemotherapy.