Effect of Weight Loss on Survival in Esophageal Cancer Patients undergoing Neoadjuvant Chemoradiotherapy and Surgery

Objective This study aimed to determine the impact of weight loss during neoadjuvant chemoradiotherapy on the survival of patients with esophageal carcinoma.Methods We retrospectively examined 102 consecutive patients with esophageal carcinoma who underwent neoadjuvant chemoradiotherapy followed by radical resection at Sichuan Cancer Hospital&Institute between 2003 and 2017.The patients were divided into three groups based on the amount of body weight lost during neoadjuvant chemoradiotherapy:severe weight loss(>10%),high weight loss(5%~10%),and low weight loss(<5%).The correlations of weight loss with toxicity,progressionfree survival,and overall survival were investigated.Results The median overall survival was 49.7 months in the low weight loss group compared with 35.4 and 25.1 months in the high and severe weight loss groups(P=0.041).The 1-year overall survival rates in the severe,high,and low weight loss groups were 62.5%,85.0%,and 90.7%,respectively;the corresponding 3-year overall survival rates were 21.9%,47.3%,and 68.8%,respectively,and the corresponding 5-year overall survival rates were 21.9%,31.0%,and 44.4%,respectively.The multivariate analysis indicated that a pathological complete response and severe weight loss were independent prognostic factors for overall survival.Any leukopenia(P=0.024),leukopenia of at least grade 3(P=0.021),and anemia(P=0.042)occurred more frequently in the severe weight loss group.Conclusions Weight loss during neoadjuvant CRT is an independent and adverse prognostic factor in esophageal carcinoma patients,whereas a stable weight confers a better prognosis.

Effects of Radiation on Protein

Radiotherapy is one of the most common treatments used for solid tumors.Proteins are important components of all cells and tissues,and the main material basis of life.In the present research,more attention has been paid to the relationship between tumor radiotherapy and glycolipid metabolism,but less attention has been paid to the post-radiation effect of proteins.This article discusses the direct and indirect effects of radiation on proteins.The direct effects include changes in the structure and function of proteins,as well as to their synthesis and degradation,with the most specific effects observed on the post-translational modification of proteins.Indirect effects include changes in the whole-body nutrition level of patients,including the process of protein intake,digestion,absorption and metabolism.This article also addresses the impact of advanced radiotherapy technology,such as proton therapy and heavy ion therapy on proteins,and emphasizes the importance and feasibility of protein-supplying nutritional treatment during the“peri-radiotherapy period”.

Multimodal Prevention Strategies for Cancer Cachexia

Cachexia is one of the most common complications in patients with malignant tumors.The occurrence and development of cancer cachexia can be diagnosed and prevented at an early stage,so prevention should be given as soon as possible to at-risk patients diagnosed with a malignant tumor.Multi-level and individualized measures should be taken based on the development of the tumor and the patient’s nutritional status.Cachexia should be prevented using a four-dimensional prevention strategy,that is,Pharmaceuticals-Exercise-Nutrition-Psychotherapy(PENP).With the development of precise medical science,metabonomics-based methods should be used to explore the development of molecular markers to predict the risk of cachexia,and to provide the basis for early prevention.