ONC: Esophageal Cancer: Chemoradiation and Use of Parenteral 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: use of parenteral nutrition and chemoradiation
Use of parenteral nutrition (PN) to prevent weight loss or improve effectiveness of treatment for patients with esophageal cancer receiving chemoradiation therapy (CRT) is not recommended. PN has not been shown to prevent weight loss or improve effectiveness of treatment, even though patients were able to tolerate a higher dose of CRT. PN may have adverse effects such as complications related to refeeding syndrome, inadequate glycemic control and increased risk of infections.
Risks/Harms of Implementing This Recommendation
No potential risks or harms are associated with the application of this recommendation.
Conditions of Application
The higher cost, increased risk and no benefit does not justify the use of PN.
Potential Costs Associated with Application
No obvious costs are associated with the application of this recommendation.
- One neutral quality retrospective review (Sikora et al, 1998) found that patients who received PN during CRT for esophageal cancer, at 30-35 kcals/kg/day and 1.0 - 1.5 g protein/kg/day, during the treatment period (21 - 28 days), tolerated higher doses of chemoradiation than a comparison group which received no PN support.
- The PN group experienced significant decreases in weight during treatment compared to the group not receiving PN. There were no significant differences between the groups in chemoradiation toxicities, chemoradiation-related deaths, post-surgical complications, total hospital stay, total days in the ICU, treatment response, or mortality. While patients receiving PN were more likely to receive scheduled chemoradiation therapy compared to patients who did not receive PN, it did not result in improved effectiveness of this treatment regimen in esophageal cancer patients.
Recommendation Strength Rationale
- Based on one neutral quality retrospective chart review study, conclusion statement is a 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 parenteral 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
Skipper A, Millikan KW. Parenteral nutrition implementation and management. In: The ASPEN Nutrition Support Practice Manual. Silver Spring, MD: American Society of Parenteral and Enteral Nutrition; 1998; 9-12.