Malnutrition caused by pre-surgery chemotherapy is associated with rectal cancer treatment outcomes

This study investigated the association between malnutrition caused by pre-surgery chemotherapy and radiation (CRT) and rectal cancer treatment tolerance and anastomotic leakage (AL; leakage of intestinal fluids). Researchers reported that malnutrition related to CRT is associated with treatment tolerance and AL.

CRT is the most used therapy for reducing the risk of rectal cancer recurrence (when the cancer comes back). Loss of appetite is one of the most common CRT negative effects. Prior studies reported that malnutrition is a risk factor for post-surgery complications, such as AL. It is also known that malnutrition has a negative effect in treatment tolerance and survival. However, malnutrition is not seen as a negative effect of CRT in rectal cancer, or an outcome that requires nutritional support. 

The objective of this study was to investigate the incidence of malnutrition caused by CRT in rectal cancer patients. Other objectives were to assess how malnutrition affects tolerance to treatment, post-surgery complications (such as AL) and disease free-survival (DFS; time from surgery to recurrence).

This study included 110 patients with stage 3 and 4 cancer (spread to the lymph nodes and to other areas of the body) divided in two groups: patients who did or did not receive CRT. Patients were followed to measure weight loss and other nutritional indicators at completion of CRT and at surgery.

Malnutrition was noted in 51% of patients after CRT and 29% at surgery. Loss of appetite and diarrhea were associated with malnutrition after CRT. Only 48% of the patients with malnutrition completed CRT due to less tolerance to treatment. AL occured in 27.3% of patients who underwent CRT compared to 9.5% of those who did not. DFS at 2 years was 22% for patients with AL and 89% for patients without AL. Five out of ten patients with AL experienced recurrence.

This study showed that malnutrition due to CRT is common and is associated with treatment tolerance and anastomotic leakage.  

Discuss the possibility of nutritional support with your doctor if you are experiencing appetite loss or malnutrition due to chemotherapy and radiation.