Randomized study of the clinical effects of omega-3 fatty acid-containing enteral nutrition support during neoadjuvant chemotherapy on chemotherapy-related toxicity in patients with esophageal cancer

Abstract Objectives Omega-3 (n-3) fatty acids have potential positive effects during chemotherapy, such as body weight maintenance and muscle mass preservation. However, little is known regarding the effect of this supplementation on reducing chemotherapy-induced toxicities. Methods Sixty-one patients undergoing neoadjuvant chemotherapy for esophageal cancer randomly received n-3-rich enteral nutrition (EN) (n=31) or n-3-poor EN support (n=30) for 15 days during chemotherapy. The daily dosage of n-3 fatty acids was 900 mg in the n-3-rich group and 250 mg in the n-3-poor group. The primary endpoint was the frequency of grade 3/4 neutropenia, and the secondary endpoints included other chemotherapy-related adverse events, body weight and inflammatory markers. Results The total and dietary intake calories during chemotherapy were equal in the two groups. There was no significant difference in the body weight change after chemotherapy between the two groups. There was no significant difference in the incidence of grade 3/4 leukopenia and neutropenia (p>0.05). However, stomatitis was significantly less frequent in the n-3-rich group, compared with the n-3-poor group (p=0.018). Grade 3/4 diarrhea was also relatively less frequent in the n-3-rich group compared with the n-3-poor group; however, this difference was not significant (16.1 vs 36.7 %, respectively, p=0.068). Increases in the aspartate aminotransferase and alanine aminotransferase levels were significantly less frequent in the n-3-rich group compared with the n-3-poor group (p=0.012 and p=0.015, respectively). Conclusions N-3-rich EN support decreased the frequency of chemotherapy-induced mucosal toxicities, such as stomatitis and diarrhea, and exhibited a hepatoprotective effect during chemotherapy, compared with n-3-poor EN support.