The effects of
parenteral nutrition in the treatment of patients with severe chronic radiation
enterocolitis is not known. We retrospectively studied 19 adult patients who received
parenteral nutrition during 8.6 +/- 2.4 months (mean +/- SEM), including 6 cases in our
home-parenteral nutrition-program.
Parenteral nutrition was started 49 +/- 12 months after
radiation therapy; follow-up after
parenteral nutrition was 22 +/- 7 months. Indication for
parenteral nutrition was
malnutrition (weight = 73 +/- 2 p. 100 of ideal body weight,
serum albumin level = 27 +/- 1 g/l) due to multifocal gastrointestinal
radiation injuries with
stenoses (n = 12), fistulae (n = 3) and
short bowel syndrome (n = 4).
Parenteral nutrition was given during the peri-operative period in 15 patients. Neither fistulae nor
stenoses resolved with
parenteral nutrition alone (n = 7) or in association with
steroids (n = 5). There was a 57 p. 100 mortality rate (11 patients): 10 p. 100 were postoperative (2 of the 3 patients with fistulae), 21 p. 100, due to radiation complications and 26 p. 100, due to progression of
cancer. In those patients with severe and multifocal chronic radiation enteropathy,
parenteral nutrition did not influence the lesions in the digestive tract.
Nutritional support could, however, be considered as an useful adjunct with a low perioperative mortality rate. In the 14 patients without superimposed unresponsive
cancer,
parenteral nutrition followed by curative abdominal surgery seemed to be associated with the best prognosis and in 7 of the 8 survivors,
parenteral nutrition has been discontinued without reappearance of clinical
malnutrition.