The application of continuous enteral nutrition during sequential chemoradiotherapy and immunotherapy in patients with esophageal cancer: a retrospective study.

PURPOSE: Patients with esophageal cancer primarily face nutritional challenges due to swallowing difficulties and gastrointestinal side effects from treatment. This study aimed to evaluate whether, on the basis of sequential chemoradiotherapy combined with immunotherapy (sandwich regimen), proactive continuous nutrition management can improve patients' nutritional status, help maintain host immune homeostasis, reduce treatment-related severe toxicities, and enhance patients' treatment tolerance.

METHODS

We performed a single-center retrospective study including 60 esophageal cancer patients treated with sandwich regimen at The Third Affiliated Hospital of Nanjing Medical University from June 2021 to May 2023. Patients were divided into the proactive continuous nutritional management (PCNM) group and the reactive nutritional intervention (RNI) group by different nutritional support strategies during sandwich regimen, and compared pre-post nutritional intervention BMI changes, nutritional risk improvement, immune function, and physical performance status indicators, as well as evaluated the clinical efficacy and safety of the treatment.

RESULTS

After intervention, the PCNM group showed significant improvements in BMI and nutritional risk status compared with the RNI group. Meanwhile, the PCNM group exhibited higher CD4+/CD8+ ratio, serum IgG and IgA levels, as well as a lower incidence of malnutrition and radiation esophagitis. Multivariate logistic and linear regression analyses further confirmed that PCNM was an independent protective factor for ameliorating nutritional risk and elevating ΔBMI. No significant intergroup difference was observed in objective tumor treatment efficacy.

CONCLUSION

Proactive continuous nutritional management improves patients' nutritional status and immune-related laboratory parameters during sequential sandwich therapy.