title: Evaluation of dietetic intervention in children with medulloblastoma or supratentorial primitive neuroectodermal tumors.
abstract: BACKGROUND
  Malnutrition is a common complication of cancer treatment; it can affect energy levels and, as a consequence, quality of life. The goal of the current study was to evaluate the effect of dietetic intervention in a cohort of children treated for medulloblastoma and supratentorial primitive neuroectodermal tumors (PNET) over a 10-year period.
  
  
  METHODS
  A retrospective chart review (1992-2002) of newly diagnosed cases of medulloblastoma/supratentorial PNET was performed. Hospital records were reviewed for data, including demographic characteristics, patient heights and weights, and information on treatment modalities and the use of dietetic intervention. Percent changes in body weight were calculated at time points associated with particular stages of treatment or dietetic intervention.
  
  
  RESULTS
  One hundred three of 112 cases were evaluable. Treatment methods included surgery only (7.8%), surgery + radiotherapy (16.5%), surgery + chemotherapy (14.5%), and surgery + radiotherapy + chemotherapy (61.2%). There was no significant change in patient weight due to surgery (median change in body weight [MCBW], -0.35%) or radiotherapy (MCBW, -0.78%). In contrast, children experienced significant weight loss (MCBW, -4.35%; P < 0.0001) 3 months after starting chemotherapy. A dietician saw 53 of the 103 children in the study cohort. There were 84 dietetic interventions (oral, 36%; parenteral, 27%; enteral, 37%) among these 53 patients. Oral diets did not result in weight gain. Parenteral nutrition was associated with significant weight gain at 1 month (MCBW, +2.7%; P = 0.03), but not at 3 months. The use of enteral feeds resulted in significant weight gain at 1 month (MCBW, +4.8%; P = 0.006) and at 3 months (MCBW, +11.8%; P < 0.0001).
  
  
  CONCLUSIONS
  Current multimodality treatment of intracranial PNET results in significant nutritional morbidity, primarily due to the use of intensive chemotherapy regimens. Dietetic input for pediatric patients with medulloblastoma/PNET is essential, and the implementation of enteral feeding in these children can help to reverse their nutritional morbidity.
authors.affiliation: Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
authors.forename: Jaimie
authors.initials: J
authors.lastname: Bakish
authors.forename: Darren
authors.initials: D
authors.lastname: Hargrave
authors.forename: Nauman
authors.initials: N
authors.lastname: Tariq
authors.forename: Normand
authors.initials: N
authors.lastname: Laperriere
authors.forename: James T
authors.initials: JT
authors.lastname: Rutka
authors.forename: Eric
authors.initials: E
authors.lastname: Bouffet
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000150:complications*; D002528:Cerebellar Neoplasms / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004032:Diet; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008527:Medulloblastoma / Q000150:complications*; D009017:Morbidity; D018242:Neuroectodermal Tumors, Primitive / Q000150:complications*; D009748:Nutrition Disorders / Q000209:etiology* / Q000628:therapy*; D009752:Nutritional Status; D010288:Parenteral Nutrition; D011788:Quality of Life; D012189:Retrospective Studies; D015430:Weight Gain