| Objective(1)to evaluate the effect of nutritional support on the prognosis of patients systematically with nasopharyngeal carcinoma(NPC)treated by radiotherapy,and to understand the current research situation in this field and the problems worthy of empirical research.(2)to extract the medical records of patients with nasopharyngeal carcinoma undergoing radiotherapy and chemotherapy,to understand the types of side effects and to analyze the differences in the incidence of side effects caused by differences in general demographic characteristics and living habits.(3)to explore the relationship between the physiological and biochemical indexes of patients before radiotherapy and chemotherapy on the time and degree of side effects of nasopharyngeal carcinoma after radiotherapy and chemotherapy,so as to provide basis for the improvement of their quality of life after radiotherapy and chemotherapy.To provide guidance for clinical intervention.Method(1)We systematically searched China knowledge Network,Wanfang Database,China Biomedical Literature Database,Webofscience,Pubmed,the Cochrane Library,EMbase and other databases about the effects of nutritional support on radiotherapy patients with nasoph aryng eal carcinoma from January 2004 to June 2019.Meta analysis was perf ormed on Stata12.0 software,Q and I~2 statistics were used to test heterogeneity,and funnel chart was used to evaluate publication bias.(2)retrospective study and analysis of NPC patients who received radiotherapy and chemotherapy in Hunan Cancer Hospital and affiliated Hospital of Nanhua University from 2016 to 2018,the collected data were recorded into EPi Data3.1,to collate the data and draw Pareto map with Excel(WPS2019),and the differences of side effects were compared by univariate analysis and logistics regression analysis using SPSS19.0software.(3)in a follow-up study,150 nasopharyngeal carcinoma inpatients in Hunan Cancer Hospital were enrolled in a 6-month clinical observation,and the baseline level of study variables was measured before radiotherapy and chemotherapy.and the occurrence of side effects were dynamically monitored.The information of the questionnaire was inputted by EPi Data3.1 and sorted out by Excel(WPS2019).Using SPSS19.0 software,the generalized estimation equa tion is used to analyze the influencing factors of different side effects.Result(1)A total of 13 randomized controlled trials were included,with a total sample size of 1296.The results of meta-analysis showed that BMI[OR=0.325,95%CI(0.107～0.991)],hemoglobin[SMD=0.926,95%CI(0.56～1.293)],albumin[SMD=0.726,95%CI(0.479～0.973)]and radiation skin reaction(gradeⅢ-Ⅳ)[OR=0.242,95%CI(0.171)]in patients with nasopharyngeal carcinoma who received radiotherapy thro ugh nutrition support.0.343)]were better than those in the control group(without nutritional support).There was no significant difference in the incidence of oropharyngeal mucosal injury(grade4)[OR=0.929,95%CI(0.576～1.479)].(2)the total sample size was 1071,including 996 med ical records.The results of Pareto map showed that the cumulative percentage of class A principal components were acute mucosal reaction(916 cases,26.13%),dry mouth(750 cases,21.23%),skin injury(655cases,18.69%)and myelosuppression(569 cases,16.23%).The influ encing factors related to acute mucosal reaction were the treatment regimen of patients(P=0.031),the incidence of simultaneous radio therapy and chemotherapy group was higher than that of radiotherapy group,and the influencing factor of xerostomia was gender(P=0.000)of patients with xerostomia,and the incidence of skin reaction was higher in males than in females,but no related factors were found in skin reaction.The influencing factors related to myelosuppression were BMI value and treatment regimen,BMI:univariate analysis and logistics analysis.The incidence rate of normal group was higher than that of overweight and obese group.Treatment plans:univariate analysis and logistics analysis showed that induction+radiotherapy,simultaneous radiotherapy and chemotherapy and induction+concurrent radiotherapy and chemotherapy groups had a higher incidence than patients with radiotherapy alone.(3)the follow-up study showed that after five follow-up,the incidence of mucosal reaction was the highest(79.1%),followed by dry mouth(76.4%),and the lowest incidence of myelosuppression(48.0%).Using the generalized estimation equation analysis,there was no significant difference in mucosal reaction among different grades(P>0.05).The significant independent variables were nutritional risk before radiotherapy(P=0.001)and dietary pattern dominated by animals(P=0.033).There were significant differences among different grades of xerostomia.The significant independent variables were nutritional risk before radiotherapy(P=0.000),dietary pattern mainly based on plants(P=0.037),primary dose of PGTVnx(P=0.000)and the number of white blood cells(P=0.036).There was no significant difference in different grades of skin injury(P>0.05).Significant independent variables were nutritional risk before radiotherapy and chemotherapy(P=0.005),dietary pattern was dominated by plants(P=0.035);,myelosuppression was significantly different).The significant independent variables were the primary dose of PGTVnx and the number of red blood cells,and there was no significant difference among different grades of gastrointestinal reaction(P>0.05).The significant independent variables were nutritional risk before radiotherapy and chemotherapy(P=0.000),dietary pattern mainly based on plants(P=0.000),red blood cell count(P=0.026),white blood cell count(P=0.004)and anemia(P=0.001).Conclusion(1)A series of literature studies have found that nutritional support plays a positive role in maintaining the nutritional indexes of patients with nasopharyngeal carcinoma during radiotherapy and reduces the risk of acute radiation dermatitis(gradeⅢandⅣ).At present,it is not clear whether nutritional support can reduce oral mucosal injury,which needs to be further studied.(2)retrospective study found that the main side effects of radiotherapy and chemotherapy in patients with nasopharyngeal carcinoma were acute mucosal reaction related to the treatment plan,xerostomia related to the patient’s sex,and myelo suppression to the patient’s BMI and treatment regimen.(3)for patients with nasopharyngeal carcinoma undergoing radiotherapy and chemo therapy,early nutritional intervention can effectively slow down the occurrence of side effects,and balanced diet or animal-based dietary pattern can resist the risk of side effects. |
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