Nutritional intake or absorption may be compromised by radiation therapy (RT) when large portions of the gastrointestinal tract are treated. Dietary counseling, oral supplements, tube feedings and intravenous hyperalimentation (IVH) have been employed to limit weight loss and lessen intestinal RT side effects. Unfortunately, no prospective study reviewed has shown improved tumor control or patient survival. Special diets and IVH have also been employed in select patients to relieve chronic malabsorption from severe radiation enteritis.
Cancer 55:263-267, 1985.
EIGHT LOSS and malnutrition may develop in patients as a result of a variety of side effects when portions of the gastrointestinal (GI) tract are treated by radiation therapy (RT). (Table ). Insufficient oral intake may occur as a result of mucositis, xerostomia, and alteration in taste sensation when the oral cavity and oropharynx are irradiated. Dysphagia will also occur when the hypopharynx or esophagus is treated. Anorexia, nausea and vomiting may occur when thickened saliva results from irradiation of the salivary glands or when large portions of the thorax or abdomen are in the treatment fields. When the small bowel is irradiated, malabsorption and diarrhea may result.
The severity and frequency of resulting weight loss and malnutrition are dependent upon the extent of GI tract irradiated. A review of 35 patients at the City of Hope National Medical Center with Stage I or I1 cancer of the larynx revealed that when RT fields were less than 7 X 7 cm, only 19% lost weight, with an average weight loss of 1.5 kg. When fields were larger than 7 X 7 cm, 67% lost weight with an average loss of 5.3 kg. No patient in the small-field group lost greater than 10% of their initial body weight, but two of nine did in the large-field group (Table ) .
Similarly, treatment of the whole abdomen usually produces more severe intestinal side effects than treatment of only the pelvic region. Donaldson and Lenon reported that among 67 lymphoma patients receiving