鼻咽癌放疗营养与消化影响的评估：法国多中心回顾性DRAKAR研究

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中文摘要

目的： 鼻咽癌放疗常伴随消化道与营养相关毒性、体重下降（WL）及营养不良，这些是耐受性差和预后不良的判定标准。DRAKAR研究的主要目的是评估预防性肠内营养（EN）对来自非流行区法国人群的鼻咽癌患者在放疗期间、放疗结束时及放疗后体重变化（WC）的影响。
材料与方法： DRAKAR是一项在法国五个中心开展的回顾性、多中心研究。患者于2015年至2024年间因原发性鼻咽癌接受根治性放疗，伴或不伴同步化疗。主要终点为放疗结束时按营养支持方式分组的WC。次要终点包括中度和重度营养不良发生率（一个月内体重下降5%或10%分别定义为中度和重度营养不良）、≥3级毒性、剂量学参数（体积、粒子）、EN和肠外营养的使用及持续时间、因治疗中断导致的放疗延长、住院以及总生存。
结果： 在分析的124例患者中（59.7%为未分化癌UCNT，40.3%为鳞状细胞癌），放疗结束时平均WC为-6.45%。一个月时，35.5%的患者存在营养不良，而治疗前为8%。55.6%的患者使用了EN，其中16.1%为预防性使用。预防性EN与治疗后WC稳定相关。关于营养不良，年龄<55岁是唯一与其发生显著相关的临床因素，未发现与毒性、剂量学或治疗特征相关。
结论： 在接受鼻咽癌治疗的患者中，预防性EN与治疗后WC稳定相关，但与住院或生存改善无关。鉴于可能存在适应证混杂，这些发现应谨慎解读，需要前瞻性研究来确认预防性EN的获益及最佳适应证。

英文摘要

OBJECTIVE: Radiotherapy for nasopharyngeal cancers is associated with frequent digestive and nutritional toxicities, weight loss (WL), and malnutrition, criteria of poor tolerance and poor prognosis. The primary objective of DRAKAR was to evaluate the effect of prophylactic enteral nutrition (EN) on weight change (WC) during, at the end of, and after radiotherapy in patients with nasopharyngeal cancer from a non-endemic French population.
MATERIALS AND METHODS: DRAKAR is a retrospective, multicenter study conducted in five French centers. Patients received radiotherapy with curative intent, with or without concurrent chemotherapy, for primary nasopharyngeal cancer between 2015 and 2024. The primary endpoint was WC according to nutritional support modality at the end of radiotherapy. Secondary endpoints included rates of moderate and severe malnutrition (5% or 10% WL in one month for moderate and severe malnutrition), grade ≥ 3 toxicities, dosimetry parameters (volumes, particles), use and duration of EN and parenteral nutrition, prolonged radiotherapy due to treatment interruption, hospitalizations, and overall survival.
RESULTS: Among the 124 patients analyzed (59.7% UCNT, 40.3% squamous cell carcinoma), mean WC was -6.45% at the end of radiotherapy. At one month, 35.5% were malnourished, compared with 8% before treatment. EN was used in 55.6% of patients, including 16.1% prophylactically. Prophylactic EN was associated with stabilization of WC after treatment. Regarding malnutrition, age < 55 years was the only significant clinical factor associated with its occurrence, with no association found with toxicity, dosimetric, or therapeutic characteristics.
CONCLUSION: In patients treated for nasopharyngeal cancer, prophylactic EN was associated with post-treatment WC stabilization but not with hospitalization or improved survival. Given potential confounding by indication, these findings should be interpreted cautiously, and prospective studies are needed to confirm the benefit and optimal indications for prophylactic EN.