study of nutrition regimens in treating patients with cancer of the upper aerodigestive tract

Conditions: Head and Neck Cancer; Infection; Malnutrition

Summary: rationale: it is not yet known which regimen of enteral nutrition is more effective in preventing infections in patients undergoing surgery for cancer of the upper aerodigestive tract. purpose: this randomized phase iii trial is comparing three nutrition regimens in treating patients with cancer of the upper aerodigestive tract.

objectives: primary * determine the efficacy of immunonutrition (impact®) in patients with de novo cancer of the upper aerodigestive tract. secondary * determine the best time to initiate treatment. * compare the intermediate duration of treatment. * compare nutritional parameters. outline: this is a multicenter study. patients are randomized to 1 of 3 treatment arms. * arm i: patients receive standard oral or enteral nutrition (impact® placebo) over 7 days prior to surgery and over 7 days after surgery. * arm ii: patients receive oral or enteral neoadjuvant impact® nutrition over 7 days prior to surgery and enteral adjuvant standard nutrition (impact® placebo) over 7 days after surgery. * arm iii: patients receive oral or enteral impact® nutrition over 7 days prior to surgery and enteral adjuvant impact® nutrition over 7 days after surgery. after completion of study therapy, patients are followed at 30 days after surgery and then at 2 and 3 months.

Eligibility criteria:
disease characteristics: * diagnosis of de novo cancer of the upper aerodigestive tract, including the following: * oral cavity * larynx * oropharynx * hypopharynx * planned surgical excision of tumors with opening of the mucous membranes, with or without immediate reconstruction by myocutaneous pedicle flap or free-bone graft * planned adjuvant enteral nutritional regimen lasting at least 7 days post-operatively patient characteristics: * anc \> 1.8 x 10\^9/l * hemoglobin \> 9 g/dl * transaminases ≤ 3 times upper limit of normal (uln) * bilirubin ≤ 3 times uln * creatinine 70-250 μmol/l * urea ≤ 1.5 times uln * glucose \< 1.5 g/l * sodium \< 145 mmol/l * not pregnant or nursing * fertile patients must use effective contraception * no psychological, social, geographical, or familial reasons prohibiting follow-up * no insulin-dependent diabetes * no severe psychiatric illness prior concurrent therapy: * no head and neck surgery for cancer within the past year * no prior oral components of immunonutrition * no prior neoadjuvant chemotherapy * no prior radiotherapy to head and neck

Keywords: infection malnutrition stage i adenoid cystic carcinoma of the oral cavity stage i mucoepidermoid carcinoma of the oral cavity stage i verrucous carcinoma of the oral cavity stage ii adenoid cystic carcinoma of the oral cavity stage ii mucoepidermoid carcinoma of the oral cavity stage ii verrucous carcinoma of the oral cavity stage iii adenoid cystic carcinoma of the oral cavity stage iii mucoepidermoid carcinoma of the oral cavity stage iii verrucous carcinoma of the oral cavity stage iv adenoid cystic carcinoma of the oral cavity stage iv mucoepidermoid carcinoma of the oral cavity stage iv verrucous carcinoma of the oral cavity stage i squamous cell carcinoma of the larynx stage i verrucous carcinoma of the larynx stage ii squamous cell carcinoma of the larynx stage ii verrucous carcinoma of the larynx stage iii squamous cell carcinoma of the larynx stage iii verrucous carcinoma of the larynx stage iv squamous cell carcinoma of the larynx stage iv verrucous carcinoma of the larynx stage i lymphoepithelioma of the oropharynx stage i squamous cell carcinoma of the oropharynx stage ii lymphoepithelioma of the oropharynx stage ii squamous cell carcinoma of the oropharynx stage iii lymphoepithelioma of the oropharynx stage iii squamous cell carcinoma of the oropharynx stage iv lymphoepithelioma of the oropharynx stage iv squamous cell carcinoma of the oropharynx stage i squamous cell carcinoma of the hypopharynx stage ii squamous cell carcinoma of the hypopharynx stage iii squamous cell carcinoma of the hypopharynx stage iv squamous cell carcinoma of the hypopharynx tongue cancer