Correlation between nutritional status and toxicity of concurrent chemoradiotherapy in patients with rectal cancer

Objective: To analyze the correlation between nutritional status and acute toxicity induced by concurrent chemoradiotherapy in patients with rectal cancer. Methods: A total of 115 patients with rectal cancer who underwent concurrent chemoradiotherapy in Zhejiang Cancer Hospital from March 2018 to August 2019 were prospectively selected. Nutritional risk was assessed by NRS 2002 and PG-SGA nutritional screening tools before, during and after radiotherapy. The acute toxicity was assessed by RTOG and CTCAE 3.0 scoring criteria. The correlation between nutritional status and the acute toxicity of chemoradiotherapy was analyzed by Spearman's correlation analysis. Results: The nutritional risk of the cohort was gradually increased from the beginning of chemoradiotherapy to the fourth week of chemoradiotherapy, and then decreased gradually. Spearman's correlation analysis showed that NRS 2002 and PG-SGA scores were positively correlated with acute hematological toxicity (r = 0.26, P < 0.05; r = 0.31, P < 0.01), upper gastrointestinal toxicity (r = 0.51, P < 0.01; r = 0.63, P < 0.01), proctitis (r = 0.23, P < 0.05; r = 0.45, P < 0.01) and fatigue (r = 0.47, P < 0.01; r = 0.64, P < 0.01) in patients with rectal cancer undergoing chemoradiotherapy. The correlation coefficients between PG-SGA and various toxicities were higher than those of NRS 2002. Stratified analysis showed that patients with stage II-III B, age < 65 years and postoperative adjuvant chemoradiotherapy, nutritional status was significantly associated with the severity of toxicity (all P < 0.05). Conclusions: Patients with rectal cancer has a high risk of malnutrition during concurrent chemoradiotherapy. The higher the risk of malnutrition, the greater the acute toxicity of chemoradiotherapy. Therefore, dynamic nutrition assessment and nutritional support should be strengthened for rectal cancer patients during chemoradiotherapy. (authors)