title: Is supplementation with elemental diet feasible in patients undergoing pelvic radiotherapy?
abstract: BACKGROUND
  Acute gastrointestinal upset occurs in approximately 80% of patients undergoing radiotherapy for pelvic cancers. Underlying changes relate to denudation of the mucosal layer which renders the small intestine vulnerable to additional damage from proteolytic enzymes and bile acids. Severe acute bowel symptoms may predispose to progressive fibrotic and ischaemic changes. Elemental diet given during treatment may reduce acute and chronic bowel symptoms induced by pelvic radiotherapy.
  
  
  METHODS
  This study aimed to assess compliance with elemental diet during pelvic radiotherapy. Patients with gynaecological, urological or rectal malignancy undergoing radical or adjuvant pelvic radiotherapy were randomised to one of five groups. Each group was assigned a target quantity of three different elemental sip feeds (Group 1, 20%, Group 2, 50%, Group 3, 75% of calorie requirements taken as E028 extra liquid; Group 4, 50% of calorie requirements taken as E028 extra powder; Group 5, 50% of calorie requirements taken as Emsogen powder). Compliance was assessed using a diary card and weekly assessment. Statistical analyses were conducted on an intention to treat basis.
  
  
  RESULTS
  Fifty patients (44 female, six male) mean age 58 yr (95% CI 55-61), were recruited to the study (24 endometrial, 17 cervical, 7 rectal, 1 vulval and 1 bladder carcinoma). Mean weight at baseline was 74.5 kg (95% CI 69-80) and this did not change during treatment. Full compliance was achieved in three patients, all from Group 1. By week 5, only 46% of patients were consuming elemental diet. Post hoc analysis of variance with repeated measures indicated that there were no significant differences in volume of elemental diet consumed between groups (P = 0.937). There was a significant inverse linear relationship between intake of elemental diet and time (P < 0.001).
  
  
  CONCLUSIONS
  Different formulations of elemental diet do not influence compliance. Patients are unlikely to be able to consume more than one-third of their calorie requirements in the form of an elemental sip feed. Further investigation is warranted to determine if intervention with this volume of elemental diet is beneficial.
authors.affiliation: Department Medicine & Therapeutics, Imperial College Faculty of Medicine, 4th Floor, Chelsea & Westminster Hospital, 369, Fulham Road, London SW10 9NH, UK.
authors.forename: C
authors.initials: C
authors.lastname: McGough
authors.forename: C
authors.initials: C
authors.lastname: Baldwin
authors.forename: A
authors.initials: A
authors.lastname: Norman
authors.forename: G
authors.initials: G
authors.lastname: Frost
authors.forename: P
authors.initials: P
authors.lastname: Blake
authors.forename: D
authors.initials: D
authors.lastname: Tait
authors.forename: V
authors.initials: V
authors.lastname: Khoo
authors.forename: K
authors.initials: K
authors.lastname: Harrington
authors.forename: H J N
authors.initials: HJ
authors.lastname: Andreyev
mesh_terms: D000704:Analysis of Variance; D003967:Diarrhea / Q000209:etiology / Q000628:therapy; D019587:Dietary Supplements; D002149:Energy Intake / Q000502:physiology*; D004734:Energy Metabolism; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009751:Nutritional Requirements; D010349:Patient Compliance; D010386:Pelvic Neoplasms / Q000532:radiotherapy*; D011878:Radiotherapy / Q000009:adverse effects; D016896:Treatment Outcome