Role of nutritional status and intervention in oesophageal cancer treated with definitive chemoradiotherapy: outcomes from SCOPE1.
BACKGROUND
Malnutrition is common in oesophageal cancer. We aimed to identify nutritional prognostic factors and survival outcomes associated with nutritional intervention in the SCOPE1 (Study of Chemoradiotherapy in OesoPhageal Cancer with or without Erbitux) trial.


METHODS
Two hundred and fifty eight patients were randomly allocated to definitive chemoradiotherapy (dCRT) +/- cetuximab. Nutritional Risk Index (NRI) scores were calculated; NRI<100 identified patients at risk of malnutrition. Nutritional intervention included dietary advice, oral supplementation or major intervention (enteral feeding/tube placement). Univariable and multivariable analyses using Cox proportional hazard modelling were conducted.


RESULTS
At baseline NRI<100 strongly predicted for reduced overall survival (hazard ratio (HR) 12.45, 95% CI 5.24-29.57; P<0.001). Nutritional intervention improved survival if provided at baseline (dietary advice (HR 0.12, P=0.004), oral supplementation (HR 0.13, P<0.001) or major intervention (HR 0.13, P=0.003)), but not if provided later in the treatment course. Cetuximab patients receiving major nutritional intervention had worse outcomes compared with controls (13 vs 28 months, P=0.003).


CONCLUSIONS
Pre-treatment assessment and correction of malnutrition may improve survival outcomes in oesophageal cancer patients treated with dCRT. Nutritional Risk Index is a simple and objective screening tool to identify patients at risk of malnutrition.
Department of Oncology, Velindre Cancer Centre, Cardiff CF14 2TL, UK.
S
S
Cox
Department of Oncology, Velindre Cancer Centre, Cardiff CF14 2TL, UK.
C
C
Powell
Institute of Primary Care and Public Health, Cardiff University School of Medicine, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK.
B
B
Carter
Wales Cancer Trials Unit, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK.
C
C
Hurt
Department of Oncology, Oxford Cancer Centre, University of Oxford, Level 2 Admin, Churchill Hospital, Oxford OX3 7LE, UK.
Somnath
S
Mukherjee
Department of Oncology, Velindre Cancer Centre, Cardiff CF14 2TL, UK.
Thomas David Lewis
TD
Crosby
D000068818:Cetuximab / Q000008:administration & dosage*; D059248:Chemoradiotherapy; D004938:Esophageal Neoplasms / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D009752:Nutritional Status; D016016:Proportional Hazards Models; D016019:Survival Analysis
D000068818:Cetuximab