Ernährungsprobleme unter Radiotherapie (RT) und Radiochemotherapie (RCT)

Zusammenfassung

Radio- und Radiochemotherapie sind die dritte Therapiesäule für zahlreiche Karzinome sowohl im kurativen und auch palliativen Therapiekonzept. Die Strahlentherapie führt bei vielen Tumorpatienten, die häufig schon bei Erstdiagnose mangelernährt sind und durch die Tumorerkrankung nicht ausreichend essen können, zu weiteren ernährungsmedizinischen Problemen. Speziell Tumore im Hals-, Nasen-, Ohrenbereich sowie des Ösophagus gehören zu dieser Gruppe. Auch die Strahlentherapie der Lungenkarzinome beeinflusst das Gewebe des oberen Gastrointestinaltrakts mit Beeinträchtigung der Nahrungsaufnahme. Der untere Gastrointestinaltrakt wird durch die Bestrahlung gynäkologischer Tumore, das Rektum-, Anal-, Blasen- und Prostatakarzinom beeinträchtigt mit der möglichen Folge einer Radioenteritis.

Durch neuere Techniken werden diese Nebenwirkungen immer geringer, sind aber vielfältig und bedürfen eines interdisziplinären Behandlungskonzepts unter der Behandlung und in der Langzeitnachsorge. Prophylaxe und ernährungstherapeutische Therapien unter der Radiotherapie werden dargestellt, auch mit dem Schwerpunkt, ob die Ernährungstherapie zu einer Verbesserung des Überlebens nach Strahlentherapie führt. Die Nebenwirkungen akute und chronische Radioenteritis treten häufiger auf und werden ausführlich bzgl. Prophylaxe, Therapie und Langzeitbetreuung dargestellt.

Ernährungsmedizinische Diagnostik, Betreuung und Interventionen (mittels orale Trinknahrung, enteraler und parenteraler Ernährung) müssen frühzeitig in das multimodale Therapiekonzept dieser Tumore integriert werden. Nur so ist es möglich, wie bei der Chemotherapie, Komplikationen zu vermeiden, das Tumoransprechen und speziell die Lebensqualität des Patienten zu verbessern.

Abstract

Radiotherapy, together with chemoradiotherapy, is one of the three main pillars of solid cancer therapy in both, curative and palliative, therapeutic concepts. Often tumour patients already initially present with malnutrition and they are compromised to eat normally due to the cancer. In such cases radiotherapy often contributes to further nutritional problems. This is especially true for head and neck cancer and oesophageal cancer. Furthermore, radiotherapy of lung cancer frequently causes upper gastrointestinal side effects by oesophagitis making difficulty in swallowing. But radiotherapy can also lead to radiation enteritis when it is administered to pelvic disease for gynaecologic tumours, rectal cancer, anal cancer, bladder cancer and prostate cance.

Modern radiotherapy techniques help to reduce the frequency of GI side effects but they are still a diagnostic and a therapeutic challenge. These side effects are manifold and they require an interdisciplinary therapeutic concept both, during radiotherapy and during continued follow-up. Here we present prophylactic measures and nutritional therapies during radiotherapy and we also take into account the question whether nutritional therapy can lead to longer survival after radiotherapy. Since acute and chronic radiation enteritis take an important place, we describe these in more detail regarding prophylaxis, therapy and long-term follow-up.

Nutritional medicine diagnostics, care and interventions have to be integrated early on during the course of multimodal therapeutic concepts in the form of high calorie drinks, enteral and parenteral feeding. This is a prerequisite to avoid complications, to improve tumour response and importantly to improve quality of life much in parallel to what we know from chemotherapeutic treatment concepts.

Schlüsselwörter

Radio-/Radiochemotherapie - Mangelernährung - Ernährungsbetreuung - Radioenteritis

Keywords

radio-/chemoradiotherapy - malnutrition - nutrition counselling - radioenteritis

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