Intensity-modulated radiotherapy does not decrease the risk of malnutrition in esophageal cancer patients during radiotherapy compared of three-dimensional conformal radiation therapy

Background: Esophageal cancer is a lethal disease of global scope. Radiotherapy is the main method to treat esophageal cancer; however, it concurrently leads to malnutrition. Intensity-modulated radiotherapy (IMRT) is superior to three-dimensional conformal radiation therapy (3D-CRT) in dosimetry and clinical outcomes. In this cohort study, we aimed to compare the effect of 3D-CRT and IMRT on malnutrition status. Methods: We retrospectively included 79 esophageal cancer patients (IMRT: n=27, 3D-CRT: n=52) who received radiotherapy. We collected nutrition indexes at the beginning, the second week, and the end of radiotherapy. Paired-T test was used to evaluate the nutrition status during radiotherapy in each group. Chi-square test and independent-sample T-test were applied to compare the dynamic changes of indexes between IMRT and 3D-CRT groups. Results: The baselines of the two groups are comparable. Nutrition Risk Screening 2002 (NRS-2002) score, body weight, BMI, hemoglobin, lymphocyte, total protein, and albumin values were significantly reduced during radiotherapy in both groups. The dynamic changes of nutrition indexes during radiotherapy were not significantly different between the IMRT and 3D-CRT groups. Besides, no difference was found for radiation esophagitis or treatment completion between the two groups. Conclusions: Malnutrition occurs in esophageal cancer patients during radiotherapy. IMRT did not significantly decrease the risk of malnutrition compared to 3D-CRT.