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A prospective randomized clinical trial of total parenteral nutrition in children with cancer
Insights
Total parenteral nutrition (TPN) improved nutritional status in children undergoing abdominal/pelvic radiotherapy but benefits were not sustained post-therapy. TPN should be reserved for malnourished pediatric patients receiving this intensive treatment.
Area of Science:
- Pediatric Oncology
- Clinical Nutrition
- Radiotherapy Research
Background:
- Children undergoing abdominal/pelvic irradiation with chemotherapy are at high risk for malnutrition.
- Weight loss and complications can arise from intensive cancer treatments.
- Nutritional status is critical for treatment tolerance and outcomes in pediatric cancer patients.
Purpose of the Study:
- To evaluate the efficacy of total parenteral nutrition (TPN) in previously untreated children receiving abdominal/pelvic irradiation.
- To determine if TPN improves nutritional status, treatment tolerance, and outcomes in this pediatric population.
- To identify the optimal candidates for TPN during oncologic therapy.
Main Methods:
- Prospective randomized clinical trial comparing TPN with ad libitum intake.
- Evaluation included weight/height, anthropometric measurements, and laboratory studies.
- Follow-up assessments were conducted at three months post-therapy.
Main Results:
- TPN improved nutritional status during therapy compared to controls.
- Weight declined after TPN discontinuation, with no significant long-term differences.
- TPN did not demonstrate a clear benefit on treatment tolerance in adequately nourished children.
Conclusions:
- TPN is beneficial for improving nutritional status during treatment in at-risk children.
- Its use as initial supportive therapy should be limited to malnourished or marginally malnourished pediatric patients.
- Continuous nutritional assessment is crucial, as malnutrition affects approximately 25% of children during therapy.
Abstract:
A prospective randomized clinical trial was undertaken to test the efficacy of total parenteral nutrition (TPN) among previously untreated children receiving abdominal/pelvic irradiation with or without adjuvant chemotherapy who were at risk for weight loss, malnutrition, and complications from treatment. Children were evaluated by weight/height determinations, anthropomorphic measurements, and laboratory studies. TPN was associated with an improved nutritional status during therapy as compared with control patients on ad libitum intake. However, when TPN was discontinued, weight declined and there were no differences among treated and control patients detected at three-month follow-up. Likewise there was no obvious effect from TPN on tolerance to therapy in the adequately nourished child. TPN as initial supportive therapy should be reserved for those children who are malnourished or marginally malnourished at the time of presentation. Close nutritional assessment during treatment is essential since approximately 25% of children undergoing abdominal/pelvic radiotherapy with chemotherapy can be expected to become malnourished during an initial course of therapy.