恶性肿瘤放疗患者营养治疗专家共识

1李涛，1吕家华，1郎锦义，2石汉平，3许红霞，4李宝生，5章真，6祝淑钗，7陈明，8康静波，9石安辉，

doi:10.16689/j.cnki.cn11-9349/r.2018.04.006

肿瘤代谢与营养电子杂志 >

2018 , Vol. 5 >Issue 4: 358 - 36

DOI: https://doi.org/10.16689/j.cnki.cn11-9349/r.2018.04.006

共识、指南与标准

恶性肿瘤放疗患者营养治疗专家共识

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1电子科技大学医学院附属肿瘤医院，成都 610041；2首都医科大学附属北京世纪坛医院，北京 100038；3第三军医大学大坪医院，重庆 400042；4山东省肿瘤医院，济南 250021；5复旦大学附属肿瘤医院，上海 200032；6河北医科大学第四医院，石家庄 050010；7浙江省肿瘤医院，杭州 310022；8中国人民解放军海军总医院，北京 100048；9北京大学肿瘤医院，北京 100142；10福建省肿瘤医院，福州 350014；11中山大学附属肿瘤医院（中山大学肿瘤防治中心），广州 510060；12吉林省肿瘤医院，长春 130012；13郑州大学第一附属医院，郑州 450052；14中国医科大学附属第一医院，沈阳 110001；15武汉大学中南医院，武汉 430071；16贵州省人民医院，贵阳 550002；17吉林大学白求恩第一医院，长春 130021；18中国医学科学院肿瘤医院，北京 100021；19中南大学湘雅医院，长沙 410008；20大连医科大学附属第二医院，大连 116021；21宁夏医科大学总医院，银川 750004；22昆明医科大学第一附属医院，昆明 650031；中国抗癌协会肿瘤营养专业委员会；中国医师协会放射肿瘤治疗医师分会营养治疗专委会

网络出版日期: 2021-04-12

基金资助

吴阶平医学基金（320.6750.16008）

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Expert consensus on nutrition therapy in cancer patients receiving radiotherapy

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1Sichuan Cancer Hospital Institute/Sichuan Cancer Center/School of Medicine, University of Electronic Science & Technology of China, Chengdu 610041, Sichuan; 2Beijing ShijitanHospital, Capital Medical University, Beijing 100038, China; 3Daping Hospital, Research Institute of Surgery Third Military Medical University, Chongqing 400042, China;4Shandong Cancer Hospital, Jinan 250021, Shandong, China; 5Fudan University Shanghai Cancer Center, Shanghai 200032, China; 6The Fourth Hospital of Hebei Medical University, Shijiazhuang 050010, Hebei, China; 7Zhejiang Cancer Hospital, Hangzhou 310022, Zhejiang, China; 8Navy General Hospita, Bejing 100048, China; 9Beijing Cancer Hospital, Beijing 100142, China; 10Fujian Cancer Hospital, Fuzhou 350014, Fujian, China; 11Sun Yat-Sen University Cancer Hospital /Sun Yat-sen University Cancer Center, guangzhou 510060, Guangdong, China; 12Jilin Cancer Hospital ,Changchun 130012, Jilin, China; 13The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China; 14The First Affiliated Hospital of China Medical University, Shenyang 110001, Liaoning, China; 15Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China; 16
The People's Hospital of Guizhou Province, Guiyang 550002, Guizhou, China; 17Department of Jilin University, First Clinical Hospital, Changchun 130021, Jilin China; 18Cancer Hospital Chinese Academy of Medical Science, Beijing 100021, China; 19Xiangya Hospital of Centre-south University, Changsha 410008, Hunan, China; 20The Second Affiliated Hospital of Dalian Medical University, Dalian 116021, Liaoning, China; 21General Hospital of Ningxia Medical University,Yinchuan 750004, Ningxia, China; 22The First Affiliated Hospital of Kunming Medical University, Kunming 650031, Yunnan, China; China Society for Nutritional Oncologyl, Chinese Anti-Cancer Association; Chinese Medical Doctor Association Radiotherapy Doctors Chapter Nutrition Therapy Branch

Online published: 2021-04-12

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摘要

营养不良在恶性肿瘤放疗患者中发生率高，降低治疗疗效，增加治疗副反应，因此应该对放疗患者常规进行营养风险筛查（推荐采用NRS 2002 量表）和营养评估（推荐采用PG-SGA 量表）。恶性肿瘤放疗患者在“围放疗期”需要进行全程营养管理。放疗前需根据PG-SGA 评分，放疗中需根据PG-SGA 评分和RTOG 急性放射损伤分级，放疗后需根据 PG-SGA 评分和RTOG 晚期放射损伤分级，规范化、个体化选择营养治疗方式。营养治疗方式遵循“五阶梯模式”。肠内营养途径选择遵循“四阶梯模式”。当患者无法通过肠内营养获得足够的营养需要或出现严重放射性黏膜炎、放射性肠炎或肠功能衰竭时，推荐及时联合部分或全肠外营养。恶性肿瘤放疗患者能量目标量推荐为25~30kcal/(kg·d)。在放疗过程中，患者能量需求受到肿瘤负荷、应激状态和急性放射损伤的影响而变化，因此需要个体化给予并进行动态调整。恶性肿瘤放疗患者推荐提高蛋白质摄入量，对于一般患者推荐 1.2~1.5g/(kg·d)，对于严重营养不良患者，推荐 1.5~2.0g/(kg·d)，对于并发恶液质的患者可提高到 2.0g/(kg·d)。

关键词： 恶性肿瘤; 放射治疗; 营养治疗; 共识

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1李涛，1吕家华，1郎锦义，2石汉平，3许红霞，4李宝生，5章真，6祝淑钗，7陈明，8康静波，9石安辉， . 恶性肿瘤放疗患者营养治疗专家共识[J]. 肿瘤代谢与营养电子杂志, 2018 , 5(4) : 358 -36 . DOI: 10.16689/j.cnki.cn11-9349/r.2018.04.006

Abstract

Abstract: The incidence of malnutrition was high in cancer patients receiving radiotherapy. Malnutrition may reduce the antitumor effect and increase the radiotherapy adverse reactions. NRS 2002 is recommended for nutritional risk screening, and PG-SGA is recommended for nutritional assessment. The cancer patients receiving radiotherapy should carry out whole-process nutrition management during the peri-radiation period. We should correctly assess the nutritional status of patients using PG-SGA before, during and after radiotherapy and acute radiation injury during and after radiotherapy according to RTOG criteria. Then, we can select the standardized and individualized nutrition treatment method according to the assessment result. Nutritional therapy should follow the "five-stage model". Enteral nutrition access should follow the "four-stage model". Only when the patient is unable to obtain adequate nutritional needs through enteral nutrition or the presence of severe radioactive mucositis, radiation enteritis or intestinal failure, it is recommended to combine partal or whole enteral nutrition in time. The recommended amount of energy intake for radiotherapy patients with malignant tumor is 25~30kcal/(kg·d). It should be adjusted dynamically according to tumor burden, stress state and acute radiation injury during radiotherapy. Cancer patients receiving radiotherapy are recommend higher protein intake, and 1.5~ 2.0g/(kg·d) is recommended for patients with severe malnutrition. For patients with cachexia, it can be increased to 2.0g/(kg·d).

Key words： Malignancies; Radiotherapy; Nutrition therapy; Consensus

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