Nutritional Support Indications in Gastroesophageal Cancer Patients: From Perioperative to Palliative Systemic Therapy. A Comprehensive Review of the Last Decade

Abstract

Gastric cancer treatments are rapidly evolving, leading to significant survival benefit. Recent evidence provided by clinical trials strongly encouraged the use of perioperative chemotherapy as standard treatment for the localized disease, whereas in the advanced disease setting, molecular characterization has improved patients’ selection for tailored therapeutic approaches, including molecular targeted therapy and immunotherapy. The role of nutritional therapy is widely recognized, with oncologic treatment’s tolerance and response being better in well-nourished patients. In this review, literature data on strategies or nutritional interventions will be critically examined, with particular regard to different treatment phases (perioperative, metastatic, and palliative settings), with the aim to draw practical indications for an adequate nutritional support of gastric cancer patients and provide an insight on future directions in nutritional strategies. We extensively analyzed the last 10 years of literature, in order to provide evidence that may fit current clinical practice both in terms of nutritional interventions and oncological treatment. Overall, 137 works were selected: 34 Randomized Clinical Trials (RCTs), 12 meta-analysis, 9 reviews, and the most relevant prospective, retrospective and cross-sectional studies in this setting. Eleven ongoing trials have been selected from clinicaltrial.gov as representative of current research. One limitation of our work lies in the heterogeneity of the described studies, in terms of sample size, study procedures, and both nutritional and clinical outcomes. Indeed, to date, there are no specific evidence-based guidelines in this fields, therefore we proposed a clinical algorithm with the aim to indicate an appropriate nutritional strategy for gastric cancer patients.

Effect of Home Enteral Nutritional Support Compared With Normal Oral Diet in Postoperative Subjects With Upper Gastrointestinal Cancer Resection: A Meta-Analysis

“…In addition, further studies are needed to deliver a clinically meaningful difference in the results. This was suggested in other metaanalyses which showed similar effects (53)(54)(55)(56)(57)(58)(59)(60)(61). This needs additional examination and clarification because no clear reasoning was found to clarify these outcomes.…”

Body composition dynamics and impact on clinical outcome in gastric and gastro-esophageal junction cancer patients undergoing perioperative chemotherapy with the FLOT protocol

“…Data from completed and ongoing trials investigating the effect of nutritional interventions during perioperative chemotherapy in gastric/GEJ cancer patients are limited. (Mulazzani et al 2021).…”

Clinical and economic value of oral nutrition supplements in cancer patients: a position paper from the Survivorship Care and Nutritional Support Working Group of Alliance Against Cancer.

“…Even the subjective global assessment and the fatigue scores were improved in the ONS group (49). A nutritional intervention in GI cancer patients undergoing perioperative CT should be aimed at preventing unintentional weight loss, thus reducing the risk of postoperative complications and sarcopenia, and improving the short-term survival (50). ONS administration for three months together with dietary advice in post-discharge patients at nutritional risk following colorectal cancer surgery reduced skeletal muscle loss and sarcopenia prevalence, as well as improved CT tolerance, compared to the group with dietary advice alone, thus underlying the importance of ONS treatment in post-discharge patients at nutritional risk (51).…”