Weight Change Trajectory in Patients With Locally Advanced Nasopharyngeal Carcinoma During the Peri-Radiation Therapy Period

Analysis of nutritional risk, skeletal muscle depletion, and lipid metabolism phenotype in acute radiation enteritis

BACKGROUND

Radiation enteritis, which often occurs during radiation-induced acute intestinal symptoms (RIAIS), is the most common and important complication during radiotherapy for cervical cancer. RIAIS caused by abdominal and pelvic radiotherapy will affect nutrient intake, digestion, absorption, and metabolism, leading to malnutrition or poorer nutritional status. In patients with malignant tumors, malnutrition can adversely affect the curative effect and response of radiotherapy by reducing radiosensitivity, affecting the precision of radiotherapy placement and increasing the incidence of radiotherapy-related adverse reactions.

AIM

To analyze nutritional risk, skeletal muscle depletion, and lipid metabolism phenotype in acute radiation enteritis.

METHODS

Fifty patients with cervical cancer received external beam radiotherapy, and 15 patients received brachytherapy after external beam radiotherapy. Body weight, body composition parameters, nutritional risk screening (NRS) 2002 score, and blood biochemical indices of patients with cervical cancer during periradiation were tested by a one-way repeated measures analysis of variance. Metabolomics analysis was used to identify characteristic lipid metabolism pathways. Clinical factors that affect linoleic acid changes were screened using the generalized evaluation equation.

RESULTS

Among the 50 patients, 37 had RIAIS, including 34 patients with grade 1-2 RIAIS and 3 patients with grade 3 RIAIS. The NRS 2002 score of patients who underwent cervical cancer radiotherapy continued to increase during the periradiation period, and 42 patients who underwent cancer radiotherapy had nutritional deficits (NRS 2002 score ≥ 3 points) at the end of radiotherapy. Correlation analyses revealed that body weight and body mass index changes were closely associated with body fat content (R2 = 0.64/0.51). The results of the univariate analysis showed that radiotherapy time, percentage reduction of serum albumin, and percentage reduction of serum prealbumin were the key factors affecting skeletal muscle exhaustion (P < 0.05). Metabolomic analysis of fecal supernatants of cervical cancer patients during the periradiation period revealed the involvement of linoleic acid, cholic acid, arachidonic acid, and N-acetyl-L-benzene alanine in the metabolic pathway of linoleic acid.

CONCLUSION

Cervical cancer radiotherapy patients faced nutritional risks, decreased serum albumin synthesis, and increased risk of skeletal muscle exhaustion. Linoleic acid was a biomarker of high nutritional risk.

Effects of Self-Care plus Forecasting Nursing on the Treatment Outcomes and Emotions in Patients with Nasopharyngeal Carcinoma after Radiotherapy

Objective

To explore the effects of self-care plus forecasting nursing on the treatment outcomes and emotions in nasopharyngeal carcinoma patients undergoing radiotherapy.

Methods

Eighty nasopharyngeal carcinoma patients after radiotherapy admitted to our hospital from February 2020 to August 2021 were selected. The patients were allocated into an observation group (n = 40) and an experimental group (n = 40) according to different nursing protocols. The observation group received traditional nursing intervention, whereas the experimental group received self-care plus forecasting nursing intervention. The levels of the indexes (quality of life, score on the Zung Self-Rating Anxiety Scale (SAS), score on the Zung Self-Rating Depression Scale (SDS), and adverse reaction) were compared between the two groups.

Results

The score of the experimental group for the quality of life was significantly higher than that of the observation group (P < 0.05); the SAS and SDS scores of the experimental group after nursing intervention were significantly lower than those of the observation group (P < 0.05); the incidence of adverse reactions in the experimental group during radiotherapy was significantly lower than that of the observation group (P < 0.05).

Conclusion

The self-care plus forecasting nursing intervention is effective in postradiotherapy patients with nasopharyngeal carcinoma. The technique is proved effective to improve the quality of life, reduce anxiety and depression, and decrease the incidence of adverse reactions in patients during treatment. These features make the technique worthy of a wider clinical application.

A Nomogram to Predict Critical Weight Loss in Patients with Nasopharyngeal Carcinoma During (Chemo) Radiotherapy

Background:

Weight loss is an important side effect of long-term anticancer treatment for nasopharyngeal carcinoma patients. The decline in body function will cause many adverse effects, such as local recurrence and distant metastasis, and reduce the patient’s quality of life. Therefore, this study developed a predictive model for the probability of critical weight loss to provide timely appropriate nutritional interventions and prevent serious side effects.

Methods:

A 20-week prospective follow-up study of 137 nasopharyngeal carcinoma patients in West China Hospital of Sichuan University undergoing radiotherapy and chemotherapy from February 2018 to March 2020 was conducted to collect relevant clinical data. The clinical usefulness and calibration of the prediction model were assessed using the C-index, calibration plot, receiver operating curve, and decision curve analysis. Internal validation was assessed using bootstrapping validation.

Results:

The nomogram consisted of sex, smoking status, physical status, chemotherapy regimen, and body mass index. Good calibration was observed for the cohort, with an area under the curve of 0.924. Five independent prognostic factors were included in the nomogram, which showed a high C-index value of 0.815 in the interval validation. Decision curve analysis showed that the nomogram was clinically useful when the intervention was decided at the critical weight loss possibility threshold in the 0% to 97% range.

Conclusions:

We constructed and validated a nomogram for predicting the incidence of critical weight loss in nasopharyngeal cancer patients undergoing chemotherapy and radiotherapy.