Prevention of the Adverse Effects of Neoadjuvant Chemotherapy for Esophageal Cancer: Role of Nutritional Management in Different Neoadjuvant Chemotherapy Regimens

Based on the results of the JCOG1109 trial, docetaxel + cisplatin + 5-fluorouracil (DCF) may be a standard neoadjuvant chemotherapy (NAC), in addition to the conventional 5-fluorouracil and cisplatin (FP) therapy. We examined whether the nutritional therapy should be modified when a different NAC is used based on the changes in body composition. The study included 215 patients with advanced esophageal cancer who underwent surgery after receiving NAC at our hospital between 2013 and 2019, and those who underwent abdominal computed tomography before and after NAC. The skeletal muscle mass index (SMI) was calculated using the following formula: total skeletal muscle mass at the third lumbar level/height 2 . The visceral and subcutaneous fat masses were assessed at the umbilical level. The lower 25% of men and women were defined as the low visceral fat and low subcutaneous fat groups, respectively. The DCF group was significantly younger (p < 0.01), had higher proportion of men (p = 0.03), and had higher proportion of patients with cStage III disease (p < 0.01) compared with the FP group. The body composition changes were not significantly different in terms of percentage changes in SMI and visceral fat mass. Multivariate analysis showed that cStage III disease and a shift to low visceral fat were prognostic factors, whereas differences in NAC were not. Although no significant difference was found in the body composition before and after NAC, aggressive nutritional management is recommended during NAC, especially because a shift to a low visceral fat affects the patient’s prognosis.