ONC: Esophageal Cancer: Chemoradiation and Use of Enteral Nutrition 2007
Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.
ONC: Esophageal cancer: Chemoradiation and use of enteral nutrition
Enteral nutrition (EN) may be used to increase calorie and protein intake in esophageal cancer patients undergoing chemoradiation therapy. EN has been shown to maintain weight, however EN has not been shown to improve tolerance to therapy or survival.
Risks/Harms of Implementing This Recommendation
- Typical risks associated with implementing EN apply (Elliott et al, 2006).
- Insertion of a PEG tube using the pull technique has been associated with an increased risk for tumor implantation in the gastrostomy site (Adelson and Ducic, 2005; Cruz et al, 2005).
Conditions of Application
No conditions are associated with the application of this recommendation.
Potential Costs Associated with Application
- Costs related to administering EN.
- One positive quality prospective, non-randomized controlled trial (Bozetti et al, 1998) found that EN for severely dysphagic esophageal cancer patients, providing 37 kcals/kg/day and 2.0 g protein/kg/day, delivered for 34 days, resulted in weight maintenance and unchanged total protein/albumin status. The control group of esophageal cancer patients classified as non dysphagic received a standard, ad libitum diet during chemoradiation. During the study, the control group experienced significant reductions in body weight, total serum protein and albumin. There were no significant differences between groups in terms of tolerance of therapy, response to therapy, suitability for radical resection, or median survival time. Note: severe dysphagia was not defined.
- Further research is needed.
Recommendation Strength Rationale
- Based on one positive quality prospective, non-randomized controlled trial, conclusion statement is Grade III.
- Risks/Harms of Implementing This Recommendation
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
Is there a relationship between enteral nutrition to enhance nutritional intake (protein, kcals) to improve tolerance and support recovery from chemoradiation therapy for esophageal cancer patients, and the reduction of complications associated with treatment?
References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process
Adelson, RT and Ducic, Y. Metastic Head and Neck Carcinoma to a Percutaneous Endoscopic Gastrostomy Site. Head Neck 27: 339– 343, 2005.
Cruz, I, Mamel, J, Brady, J, Cass-Garcia, M. Incidence of abdominal wall metastasis complicating tube placement in untreated head and neck cancer. Gastrointest Endosc 62:708-11, 2005.Elliott, L, Molseed, L, Davis-McCallum, P. editors, Grant, G, technical editor. The Clinical Guide to Oncology Nutrition, 2nd ed., Oncology Nutrition Dietetic Practice Group; American Dietetic Association, 2006.