The Effects of Early Nutritional Intervention on Oral Mucositis and Nutritional Status of Patients With Head and Neck Cancer Treated With Radiotherapy

Zhuangzhuang Zheng, Xin Zhao, Qin Zhao, Yuyu Zhang, Shiyu Liu, Zijing Liu, Lingbin Meng, Ying Xin, Xin Jiang, Zhuangzhuang Zheng, Xin Zhao, Qin Zhao, Yuyu Zhang, Shiyu Liu, Zijing Liu, Lingbin Meng, Ying Xin, Xin Jiang

Abstract

Radiation-induced oral mucositis (RIOM) is a common side effect after radiotherapy (RT) in head and neck cancer (HNC) patients. RIOM patients with severe pain have difficulty in eating, which increases the incidence of malnutrition and affects patients' quality of life and the process of RT. The mechanism of RIOM is not fully understood, and inflammatory response and oxidative stress appear to be important for RIOM occurrence and development. The nutritional status of patients is very important for their RT tolerance and recovery. Malnutrition, which can lead to anemia, low protein, decreased immunity and other problems, is an important clinical factor affecting tumor progression and treatment. Recent studies have shown that early nutritional intervention can ameliorate oral mucositis and nutritional status of patients with HNC. However, in clinical practice, early nutritional intervention for patients with HNC is not a conventional intervention strategy. Therefore, this review summarized the possible pathogenesis of RIOM, commonly used assessment tools for malnutrition in patients, and recent studies on the effects of early nutritional interventions on RIOM and nutritional status of patients with HNC. We hope to provide the basis and reference for the clinical application of early nutritional intervention models.

Keywords: early nutritional intervention; head and neck cancer; malnutrition; oral mucositis; radiotherapy.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Zheng, Zhao, Zhao, Zhang, Liu, Liu, Meng, Xin and Jiang.

Figures

Figure 1
Figure 1
Pathogenic mechanisms of radiation-induced oral mucositis (RIOM). Amplification of reactive oxygen species (ROS) and inflammatory cytokines occurs mainly through the following three steps: (1) activating the nuclear factor kappa-B (NF-κB) pro-inflammatory pathway, stimulating target gene expression, and producing a large number of inflammatory cytokines, such as tumor necrosis factor alpha (TNF-α), interleukin 1 (IL-1), and IL-6, which activate the ceramide pathway, thereby producing large amounts of sphingomyelinase and ceramide synthase and eventually causing more tissue damage and cell apoptosis; (2) fibronectin breakdown, which stimulates macrophages leading to activation of matrix metalloproteinases (MMPs); (3) impaired mitochondria produce more ROS, which activates NOD-like receptor pyrin domain-containing protein 3 (NLRP3) inflammasome pathway. NLRP3 activates caspase-1, which produces IL-1β and leads to apoptosis.

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Source: PubMed

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