Randomized Study of Antiinflammatory and Immune-Modulatory Effects of Enteral Immunonutrition During Concurrent Chemoradiotherapy for Esophageal Cancer

Abstract

Concurrent chemoradiotherapy (CCRT) induces toxicities from inflammation and immunological suppression. Omega-3 fatty acids, glutamine, and arginine are therapeutic factors that can attenuate such inflammation and promote cellular immunity. The question is whether immunonutrition (IN) during CCRT reduces inflammation and improves the immune function in patients with esophageal squamous cell carcinoma (ESCC). Seventy-one locally advanced ESCC patients being treated with CCRT (5-FU and cisplatin) were randomized into 2 groups. The IN group received a combination of omega-3 fatty acids, glutamine, and arginine, whereas the control group received standard formula. The levels of C-reactive protein (CRP), tumor necrosis factor (TNF), interferon-gamma (IFN), interleukin (IL-6, IL-10), CD3, CD4, CD8, white blood cells, neutrophils, and total lymphocytes were measured before and during treatment. The levels of CRP (P = 0.001) and TNF (P = 0.014) increased more during treatment in the control group than the treatment group, whereas IFN, IL-6, and IL-10 were similar but not significantly. CD3, CD4, CD8, white blood cells, neutrophils, and total lymphocytes decreased more in the control group than in the treatment group, but not significantly. Enteral IN during CCRT reduced the increase of inflammatory cytokine levels.

Effects of nutritional support on short-term clinical outcomes and immune response in unresectable locally advanced oesophageal squamous cell carcinoma

“…These results were consistent with those of another study that explored the effect of early enteral nutrition on post-operative immune function in elderly patients with oesophageal or cardiac cancer (Yu, Chen, Huang, Shao, & Zeng, 2013 (Sunpaweravong et al, 2014).…”

The Efficacy of Oral Nutritional Intervention in Malnourished Cancer Patients: a Systemic Review

“…Treatment-induced increases in plasma CRP and inflammatory cytokine concentrations were significantly lowered by nutritional intervention [30]. Increases in plasma CRP and TNF-α concentrations in esophageal cancer patients were significantly lowered by four weeks of EN supplementation, which contained arginine, n-3 fatty acid, and glutamine.…”

Nutritional Management of Esophageal Cancer Patients

“…One randomized clinical trial examined the effects of immunonutrition on serum cytokine and inflammatory markers, and cellular immunity in locally advanced esophageal cancer patients undergoing chemoradiotherapy. The levels of C-Reactive Protein (CRP) and TNF increased more during treatment in the control group (standard enteral nutrition) than in the treatment group, whereas all other markers did not differ significantly between the two groups [104]. In addition, the impact of immunonutrients on immune system of head and neck and esophageal cancer patients during chemoradiotherapy was examined in another randomized clinical trial.…”