放射線化学療法施行中の頭頚部癌患者への栄養介入の効果および課題について

Abstract

頭頚部癌の化学放射線併用療法では，口腔咽頭粘膜障害や嘔気・嘔吐などの多様な有害事象の発現により食事摂取量低下， 体重減少を招く．体重減少は「放射線治療完遂率の低下」や「感染症発症率の増加」などにより予後に影響するため，栄養介 入により摂取量を維持し体重減少を抑制する必要がある．本研究では，12 名の対象患者において管理栄養士による食事相談や 食事摂取状況並びに栄養状態の推移を調査し，介入による効果と課題を検証した．治療が進むにつれて嚥下時痛を訴える人数 が増加し，病院食でのエネルギー充足率は低下していたが，個々の有害事象に対応した個別調整を行うことで治療終了まで充 足率60％を確保することができた．治療が進むにつれ体重は減少傾向となり，退院時は入院時と比較し有意に減少していたが， 体重減少率が10％を超える症例は3 割程度であった．管理栄養士による食事調整を主体とした栄養介入と多職種連携によって 治療中の体重減少の抑制に繋がる可能性がある．

Concomittant chemoradiotherapy for the treatment of head and neck cancers causes decrease in food intake and weight loss due to various adverse effects such as damage to the throat membrane, nausea and emesis. Weight loss often affects the prognosis such as decrease in complete response to radiotherapy and increase in chance of contracting diseases, nutritional intervention is necessary to maintain intake and prevent weight loss. In this study, we surveyed the change in the condition of the patient who sought the advice of the registered dietitian including advice on meals, food intake and state of nutrition. We report the effects and issues of intervention. The number of patients complaining of pain increased with the chemoradiotherapy sessions, and the percentage of energy fulfillment with the hospital meals was lowered. By adjusting the meals for each person individually, the satisfaction rate remained 60% at the end of the therapy. The reduction in weight tended to continue with the treatment sessions, and was significantly decreased at the time of dispatch from hospital as compared to time of hospitalization. However,only 30% of the patients had weight loss exceeding 10%. Nutritional intervention mainly by adjusting the diet and multioccupational cooperation may help prevent weight loss during chemoradiotherapy.