BAŞ BOYUN KANSERLERİNDE NÜTRİSYON

Nütrisyon, baş ve boyun kanserli hastalarda morbidite ve mortalite üzerinde etkili faktörlerden biridir. Bu hastalarda kanserin neden olduğu olumsuz metabolik etkiler tümöre bağlı bölgesel faktörlere ek olarak gözlenir. Baş boyun bölgesine uygulanan cerrahi, radyoterapi ve kemoterapi tedavileri beslenmeyi olumsuz etkiler. Bu nedenle baş boyun kanserli hastanın tedavi öncesi beslenmesinin değerlendirilmesi, tedavi öncesi, sırasında ve sonrasında desteklenmesi gerekir. Baş boyun kanserli hastalarda beslenme desteğine ihtiyaç duyan hastalar vücut kitle indeksi 18.5 kg/m2’nin altında olan, 3-6 ayda %10 ve üzeri kilo kaybı olan, 5 gün üzerinde oral alımı azalmış ve katabolik etkilerin gözlendiği hastalardır. Planlanacak beslenme hastanın oral alımının olup olmadığı, beslenme desteğinin ne kadar süre gerekli olduğu ve besin alım sorununun kısmi veya total olmasına bağlı değişir. Oral beslenebilen hastalara gıda aralarında yüksek protein içerikli, lösin veya dallı zincirli aminoasitler ve omega-3 yağ asidinden zengin, yüksek enerji içerikli (2 kcal/mL) beslenme solüsyonları önerilir. Oral alımı olmayan hastalarda kısa süreli kullanımda parenteral beslenme, uzun süreli durumlarda veya evde hasta takibinde tüple beslenmeye geçilmelidir.

Anahtar Kelimeler:

Baş ve boyun neoplazileri, beslenme desteği, malnütrisyon

Nutrition in Head Neck Cancers

Nutrition is one of the factors that affect the morbidity and mortality in head and neck cancer. In these patients, adverse metabolic effects of cancer are seen in addition to the local factors associated with the tumor. Surgical intervention, radiotherapy and chemotherapy in head and neck region negatively affect the nutritional status. The main goal is to determine the need of nutritional support before treatment and provide it before, during and after the treatment. The head and neck cancer patients who have a body mass index less than 18.5 kg/m2, weight loss more than 10% within 3-6 months, limited oral intake more than 5 days and catabolic signs require nutritional support. Nutritional support is based on the ability of oral intake, the duration of the support and partial or total impairment of nutrition. Nutritional support with high protein ingredient, leucine or branched chain aminoacids and omega-3 fatty acids, high energy content (2 kcal/mL) are recommended for the patients with oral intake in addition to daily oral alimentation. In patients without oral intake, parenteral nutrition should be preferred for short term support while tube feeding should be preferred for long term support or home nutrition.

Keywords:

Head and neck neoplasms, diet food and nutrition, malnutrition,

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1. Kömürcü Ş. Baş ve boyun kanserli hastalarda beslenme problemi. KBB ve BBC Dergisi. 2004;12 (2):101–8.
2. Alshadwi A, Nadershah M, Carlson ER, Young LS, Burke PA, Daley BJ. Nutritional considerations for head and neck cancer patients: a review of the literature. J Oral Maxillofac Surg. 2013;71(11):1853-60. Doi: 10.1016/j.joms.2013.04.028. Pubmed PMID: 23845698. Epub 2013 Jul 9.
3. Brookes GB. Nutritional status-a prognostic indicator in head and neck cancer. Otolaryngol Head Neck Surg. 1985;93(1):69-74. Doi: 10.1177/019459988509300114. Pubmed PMID: 3920627.
4. Ravasco P, Monteiro-Grillo I, Vidal PM, Camilo ME. Nutritional deterioration in cancer: the role of disease and diet. Clin Oncol (R Coll Radiol). 2003;15(8):443-50. Doi: 10.1016/s0936-6555(03)00155-9. Pubmed PMID: 14689999.
5. Mattioli F, Bettini M, Molteni G, Piccinini A, Valoriani F, Gabriele S et al L. Analysis of risk factors for pharyngocutaneous fistula after total laryngectomy with particular focus on nutritional status. Acta Otorhinolaryngol Ital. 2015;35(4):243-8. Pubmed PMID: 26824210; PMCID: PMC4731886.
6. Goldwaser BR, Chuang SK, Kaban LB, August M. Risk factor assessment for the development of osteoradionecrosis. J Oral Maxillofac Surg. 2007;65(11):2311-6. Doi: 10.1016/j.joms.2007.05.021. Pubmed PMID: 17954330.
7. Isenring EA, Capra S, Bauer JD. Nutrition intervention is beneficial in oncology outpatients receiving radiotherapy to the gastrointestinal or head and neck area. Br J Cancer. 2004;91(3):447-52. Doi: 10.1038/sj.bjc.6601962. Pubmed PMID: 15226773; PMCID: PMC2409852.
8. Ravasco P, Monteiro-Grillo I, Marques Vidal P, Camilo ME. Impact of nutrition on outcome: a prospective randomized controlled trial in patients with head and neck cancer undergoing radiotherapy. Head Neck. 2005;27(8):659-68. Doi: 10.1002/hed.20221. Pubmed PMID: 15920748.
9. Isenring EA, Bauer JD, Capra S. Nutrition support using the American Dietetic Association medical nutrition therapy protocol for radiation oncology patients improves dietary intake compared with standard practice. J Am Diet Assoc. 2007;107(3):404-12. Doi: 10.1016/j.jada.2006.12.007. Pubmed PMID: 17324657.
10. Talwar B, Donnelly R, Skelly R, Donaldson M. Nutritional management in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(S2):S32-S40. Doi: 10.1017/S0022215116000402. Pubmed PMID: 27841109; PMCID: PMC4873913.
11. Mehanna HM, Moledina J, Travis J. Refeeding syndrome: what it is, and how to prevent and treat it. BMJ. 2008;336(7659):1495-8. Doi: 10.1136/bmj.a301. Pubmed PMID: 18583681; PMCID: PMC2440847.
12. Muscaritoli M, Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H et al. ESPEN practical guideline: Clinical Nutrition in cancer. Clin Nutr. 2021;40(5):2898-2913. Doi: 10.1016/j.clnu.2021.02.005. Pubmed PMID: 33946039. Epub 2021 Mar 15.
13. Cao DX, Wu GH, Zhang B, Quan YJ, Wei J, Jin H et al. Resting energy expenditure and body composition in patients with newly detected cancer. Clin Nutr. 2010;29(1):72-7. Doi: 10.1016/j.clnu.2009.07.001. Pubmed PMID: 19647909. Epub 2009 Aug 3.
14. MacDonald AJ, Johns N, Stephens N, Greig C, Ross JA, Small AC et al. Habitual Myofibrillar Protein Synthesis Is Normal in Patients with Upper GI Cancer Cachexia. Clin Cancer Res. 2015;21(7):1734-40. Doi: 10.1158/1078-0432.CCR-14-2004. Pubmed PMID: 25370466. Epub 2014 Nov 4.
15. Gourin CG, Couch ME, Johnson JT. Effect of weight loss on short-term outcomes and costs of care after head and neck cancer surgery. Ann Otol Rhinol Laryngol. 2014;123(2):101-10. Doi: 10.1177/0003489414523564. Pubmed PMID: 24574465.
16. Campbell IT, Morton RP, Macdonald IA, Judd S, Shapiro L, Stell PM. Comparison of the metabolic effects of continuous postoperative enteral feeding and feeding at night only. Am J Clin Nutr. 1990;52(6):1107-12. Doi: 10.1093/ajcn/52.6.1107. Pubmed PMID: 2122715.
17. Stableforth WD, Thomas S, Lewis SJ. A systematic review of the role of immunonutrition in patients undergoing surgery for head and neck cancer. Int J Oral Maxillofac Surg. 2009;38(2):103-10. Doi: 10.1016/j.ijom.2008.12.008. Pubmed PMID: 19144498. Epub 2009 Jan 13.
18. Bozzetti F, Cotogni P. Nutritional Issues in Head and Neck Cancer Patients. Healthcare (Basel). 2020;8(2):102. Doi: 10.3390/healthcare8020102. Pubmed PMID: 32316416; PMCID: PMC7348698.
19. Wallengren O, Bosaeus I, Lundholm K. Dietary energy density, inflammation and energy balance in palliative care cancer patients. Clin Nutr. 2013;32(1):88-92. Doi: 10.1016/j.clnu.2012.05.023. Pubmed PMID: 22727547. Epub 2012 Jun 23.
20. Shaw SM, Flowers H, O'Sullivan B, Hope A, Liu LW, Martino R. The effect of prophylactic percutaneous endoscopic gastrostomy (PEG) tube placement on swallowing and swallow-related outcomes in patients undergoing radiotherapy for head and neck cancer: a systematic review. Dysphagia. 2015;30(2):152-75. Doi: 10.1007/s00455-014-9592-z. Pubmed PMID: 25737196. Epub 2015 Mar 4.
21. Nourissat A, Bairati I, Fortin A, Gélinas M, Nabid A, Brochet F et al. Factors associated with weight loss during radiotherapy in patients with stage I or II head and neck cancer. Support Care Cancer. 2012;20(3):591-9. Doi: 10.1007/s00520-011-1132-x. Pubmed PMID: 21424341. Epub 2011 Mar 20.
22. Mallick I, Gupta SK, Ray R, Sinha T, Sinha S, Achari R et al. Predictors of weight loss during conformal radiotherapy for head and neck cancers - how important are planning target volumes? Clin Oncol (R Coll Radiol). 2013;25(9):557-63. Doi: 10.1016/j.clon.2013.04.003. Pubmed PMID: 23651866. Epub 2013 May 4.
23. Yadav SP, Gera A, Singh I, Chanda R. Serum selenium levels in patients with head and neck cancer. J Otolaryngol. 2002;31(4):216-9. Doi: 10.2310/7070.2002.21096. Pubmed PMID: 12240756.
24. Memorial Sloan Kettering Cancer Centre. Accessed date:20 September 2021 / Erişim tarihi: 20 Eylül 2021: https://www.mskcc.org
25. de Luis DA, Izaola O, Aller R, Cuellar L, Terroba MC. A randomized clinical trial with oral Immunonutrition (omega3-enhanced formula vs. arginine-enhanced formula) in ambulatory head and neck cancer patients. Ann Nutr Metab. 2005;49(2):95-9. Doi: 10.1159/000084742. Pubmed PMID: 15802904. Epub 2005 Mar 29.
26. Stableforth WD, Thomas S, Lewis SJ. A systematic review of the role of immunonutrition in patients undergoing surgery for head and neck cancer. Int J Oral Maxillofac Surg. 2009;38(2):103-10. Doi: 10.1016/j.ijom.2008.12.008. Pubmed PMID: 19144498. Epub 2009 Jan 13.
27. Casas Rodera P, de Luis DA, Gómez Candela C, Culebras JM. Immunoenhanced enteral nutrition formulas in head and neck cancer surgery: a systematic review. Nutr Hosp. 2012;27(3):681-90. Doi: 10.3305/nh.2012.27.3.5773. Pubmed PMID: 23114931.
28. Turnock A, Calder PC, West AL, Izzard M, Morton RP, Plank LD. Perioperative immunonutrition in well-nourished patients undergoing surgery for head and neck cancer: evaluation of inflammatory and immunologic outcomes. Nutrients. 2013;5(4):1186-99. Doi: 10.3390/nu5041186. Pubmed PMID: 23571650; PMCID: PMC3705342.
29. Sorensen D, McCarthy M, Baumgartner B, Demars S. Perioperative immunonutrition in head and neck cancer. Laryngoscope. 2009;119(7):1358-64. Doi: 10.1002/lary.20494. Pubmed PMID: 19459146.