title: Immunonutrition before and during radiochemotherapy: improvement of inflammatory parameters in head and neck cancer patients.
abstract: OBJECTIVE
  Inflammatory, angiogenic and oxidative stress markers have been explored in head and neck squamous cell carcinoma (HNSCC) patients before and during radiochemotherapy. Furthermore, the effects of an oral supplementation containing amino acids, ω-3 fatty acids, ribonucleic acids, vitamins, and antioxidants on biological markers and acute toxicities were investigated.
  
  
  METHODS
  Thirty-one patients with non-metastatic stage III or IV HNSCC treated with concomitant radiochemotherapy were recruited. A nutritional support (Oral Impact) was given during 5 days before each cycle of chemotherapy. Biological samples were collected at baseline, after 5 days of oral supplementation and before the last cycle of chemotherapy. Acute phase proteins levels, proteomic cytokines determination and urinary isoprostanes levels were used as inflammatory and oxidative stress biomarkers. Toxicities were followed up during radiochemotherapy.
  
  
  RESULTS
  At baseline, median levels of inflammatory (CRP 9.8 mg/l [0.8-130.1], IL-6 4.2 pg/ml [0.7-126.5]), pro-angiogenic (VEGF 229.5 pg/ml [13.1-595.9]) and pro-oxidative stress (urinary isoprostanes 118 pmol/mmol creatinine [51-299]) markers were increased. Decrease in CRP (p = 0.002) and α-1 acid glycoprotein (p = 0.020) levels were observed after 5 days of oral supplementation. During radiochemotherapy, no significant variation of inflammatory markers was reported, and a low incidence of severe acute mucositis was noted.
  
  
  CONCLUSIONS
  Stage III or IV HNSCC patients are characterised by a pro-inflammatory, pro-angiogenic and pro-oxidative status. Nutritional support could improve this inflammatory state and could prevent severe acute mucositis.
authors.affiliation: Department of Biochemistry, Lapeyronie Hospital, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Machon
authors.forename: Simon
authors.initials: S
authors.lastname: Thezenas
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Dupuy
authors.forename: Eric
authors.initials: E
authors.lastname: Assenat
authors.forename: Françoise
authors.initials: F
authors.lastname: Michel
authors.forename: Emilie
authors.initials: E
authors.lastname: Mas
authors.forename: Pierre
authors.initials: P
authors.lastname: Senesse
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Cristol
mesh_terms: D000209:Acute-Phase Proteins / Q000032:analysis; D000328:Adult; D000368:Aged; D000975:Antioxidants / Q000627:therapeutic use; D015415:Biomarkers; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects*; D016207:Cytokines / Q000097:blood; D019587:Dietary Supplements; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use; D005260:Female; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D028421:Isoprostanes / Q000652:urine; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000209:etiology / Q000517:prevention & control / Q000628:therapy; D018529:Nutritional Support / Q000379:methods*; D018384:Oxidative Stress; D010865:Pilot Projects; D011446:Prospective Studies; D012313:RNA / Q000627:therapeutic use; D000077195:Squamous Cell Carcinoma of Head and Neck; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D000209:Acute-Phase Proteins; D000975:Antioxidants; D015415:Biomarkers; D016207:Cytokines; D015525:Fatty Acids, Omega-3; D028421:Isoprostanes; D014815:Vitamins; D012313:RNA