Are additional trace elements necessary in total parenteral nutrition for patients with esophageal cancer receiving cisplatin-based chemotherapy?
It is known that cisplatin induces the excretion of zinc from the urine and thereby reduces its serum concentration. However, the fluctuation of these trace elements during or after cisplatin-based chemotherapy has not been evaluated. To answer this question, we performed a clinical study in esophageal cancer patients undergoing cisplatin-based chemotherapy. Eighteen patients with esophageal cancer who were not able to swallow food or water orally due to complete stenosis of the esophagus were evaluated. The patients were divided into a control group [total parenteral nutrition (TPN) alone for 28 days, ten cases] and an intervention group (TPN with additional trace elements for 28 days, eight cases). The serum concentrations of zinc, iron, copper, manganese, triiodothyronin (T3), and thyroxin (T4), as alternative indicators of iodine, were measured on days 0, 14, and 28 of treatment, and statistically analyzed on day 28. In the control group, the serum concentration of copper was significantly decreased from 135.4 (day 0) to 122.1 μg/ml (day 14), and finally to 110.6 μg/ml (day 28, p = 0.015). The concentration of manganese was also significantly decreased from 1.34 (day 0) to 1.17 μg/ml (day 14) and finally to 1.20 (day 28, p = 0.049). The levels of zinc, iron, T3, and T4 were not significantly changed. In the intervention group, the supplementation with trace elements successfully prevented these decreases in their concentrations. TPN with supplementary trace elements is preferable and recommended for patients who are undergoing chemotherapy in order to maintain the patients' nutrient homeostasis.
Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan. yakutsu@faculty.chiba-u.jp
Yasunori
Y
Akutsu
Tsuguaki
T
Kono
Masaya
M
Uesato
Isamu
I
Hoshino
Kentaro
K
Murakami
Takeshi
T
Fujishiro
Shunsuke
S
Imanishi
Satoshi
S
Endo
Takeshi
T
Toyozumi
Hisahiro
H
Matsubara
D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D003300:Copper / Q000097:blood / Q000172:deficiency / Q000627:therapeutic use; D003677:Deficiency Diseases / Q000139:chemically induced / Q000517:prevention & control; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D019587:Dietary Supplements; D004938:Esophageal Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008345:Manganese / Q000097:blood / Q000172:deficiency / Q000627:therapeutic use; D008875:Middle Aged; D010289:Parenteral Nutrition, Total; D014131:Trace Elements / Q000097:blood / Q000172:deficiency / Q000378:metabolism / Q000627:therapeutic use*; D015032:Zinc / Q000097:blood / Q000172:deficiency / Q000627:therapeutic use
D000970:Antineoplastic Agents; D014131:Trace Elements; D008345:Manganese; D003300:Copper; D015032:Zinc; D002945:Cisplatin