Effect of Nutrition Intervention on Skeletal Muscle During Concurrent Chemoradiotherapy for Esophageal Cancer

Objective To evaluate the role of nutritional intervention during concurrent chemoradiotherapy (CCRT) for esophageal cancer and investigate the incidence and risk factors of skeletal muscle loss after CCRT.Methods The clinical data of patients with esophageal cancer who underwent CCRT in our center from April 2017 to November 2019 were retrospectively collected.The CT images before and after CCRT were analyzed.The incidence of skeletal muscle loss,changes in nutritional indicators,and chemoradiotherapy delay were recorded,and the risk factors associated with declined skeletal muscle index (SMI) were analyzed.Results In the nutritional intervention group,the average daily energy intake per person in the oral nutritional supplement (ONS) subgroup,parenteral nutrition (PN) subgroup,and ONS+PN subgroup were (273.5±252.8), (310.6±311.2),and (745.3±637.8) kcal (1 kcal=4.1868 kJ),respectively,and the difference was statistically significant (F=5.870,P=0.005).After CCRT,the incidence of sarcopenia was 40.3% (n=40) in the nutrition intervention group,which was significantly lower than that (45.2%,n=42) in the control group (χ2=4.247,P=0.038);the decline of SMI in the nutrition intervention group was (1.4±8.3) cm2/m2,which was significantly lower than that in the control group [ (5.4±9.1) cm2/m2] (t=2.187,P=0.031).In the nutrition intervention group,the radiotherapy delay and chemotherapy delay occurred in 18 patients and 10 patients,which were significantly lower than those in the control group [25 patients (χ2=4.501,P=0.039) and 19 patients (χ2=8.929,P=0.005) ].The duration of radiotherapy delay and chemotherapy delay in the nutrition intervention group was (2.3±4.4) and (0.9±1.3) days,which were significantly shorter than those in the control group [ (4.2±5.3) (t=0.691,P=0.047) and (2.2±3.2) days (t=0.847,P=0.041) ].The incidence of sarcopenia was 75.2% before CCRT,which was significantly lower than that (88.2%) after CCRT (χ2=5.183,P=0.023).Multivariate linear regression analysis showed that T stage (P=0.007),N stage (P<0.001),and nutritional intervention (P=0.014) at baseline had significant effects on the decrease of SMI in patients with esophageal cancer after radiotherapy and chemotherapy.Conclusions Nutrition intervention can reduce the incidence of delayed chemoradiotherapy during esophageal cancer CCRT and reduce skeletal muscle loss.The decline of SMI is mainly related to the T stage,N stage,and nutrition intervention at baseline.