Impact of enteral nutrition on acute toxicity and treatment continuity in head and neck cancer patients submitted to intensity-modulated radiotherapy* Impacto da nutrição enteral na toxicidade aguda e na continuidade do tratamento dos pacientes com tumores de cabeça e pescoço submetidos a radioterapia com intensidade modulada

Objective: The present study was aimed at analyzing the impact of enteral nutrition on the maintenance of body weightand on the necessity of replanning and/or interruption of treatment of head and neck cancer patients undergoing intensity-modulated radiotherapy (IMRT). Materials and Methods: Cases of patients submitted to IMRT in the period from January2005 to October 2008 were retrospectively reviewed, and 83 of them were included in the study. Results: Medianpatients’ age was 58.6 years. Only five patients (6%) had their treatment interrupted for a period ranging from 4 to 18days, and in 19 cases (23%) required replanning. Enteral nutrition was initiated before the radiotherapy in 16 patients(19%). Weight loss of ≥ 5% was observed in 58 patients (70%), with a higher prevalence in the group of patients whohad not received pre-radiotherapy enteral nutrition. No significant difference was observed between the groups regardingthe necessity of radiotherapy replanning (25% versus 21%; p = 0.741) and necessity and duration of treatmentinterruption. Conclusion: Enteral nutrition is of a great value in the body weight maintenance, but no benefit was observedwith the performance of endoscopic percutaneous gastrostomy as compared with radiotherapy interruption/replanning.Keywords: Radiotherapy; IMRT; Enteral nutrition; Head and neck tumors; Toxicity.Objetivo: Analisar o impacto da terapia nutricional enteral na manutencao do peso corporeo e na necessidade dereplanejamento e/ou interrupcao da radioterapia em pacientes com câncer de cabeca e pescoco submetidos a radio-terapia de intensidade modulada (IMRT). Materiais e Metodos: Foram analisados, retrospectivamente, os pacientessubmetidos a IMRT entre janeiro de 2005 e outubro de 2008, com a inclusao de 83 casos. Resultados: A idademediana foi de 58,6 anos. Em apenas em cinco pacientes (6%) houve interrupcao do tratamento, que variou de 4 a18 dias, e em 19 casos (23%) houve necessidade de replanejamento. A terapia nutricional enteral foi instituida antesdo inicio da radioterapia em 16 pacientes (19%). Perda de peso ≥ 5% ocorreu em 58 casos (70%), sendo mais pre-valente no grupo de pacientes em que a terapia nutricional enteral nao foi instituida pre-radioterapia. Na comparacaoentre os grupos nao houve diferenca significativa na realizacao de replanejamento (25% versus 21%; p = 0,741) ouna ocorrencia e duracao da interrupcao da radioterapia. Conclusao: A terapia nutricional enteral tem um claro ganhona manutencao do peso corporal, porem, nao houve um beneficio na realizacao da gastrostomia percutânea endos-copica ou da sonda nasoenteral em relacao a interrupcao e ao replanejamento da radioterapia.Unitermos: Radioterapia; IMRT; Nutricao enteral; Tumores de cabeca e pescoco; Toxicidade.AbstractResumo