飲食中槲皮素攝取量對順鉑副作用影響

化學合併放射線治療(Concurrent Chemo-Radiotherapy, CCRT)是常見治療頭頸癌的方法之一，但接受治療後病人常因口腔黏膜炎（mucositis）、吞嚥困難、口乾（xerostomia）、疲累虛弱、疼痛、厭食、噁心等症狀而食慾不振，並進而造成營養不良，影響病人對治療的耐受度及癒後情形。本研究給於正在接受cisplatin 合併放射線治療的頭頸癌病人進行營養衛教，教導個案攝取足夠熱量及蛋白質及其重要性，並教導因應治療副作用的飲食策略，以促進其營養攝取量能達成目標，除此之外並且教導病人增加富含quercetin 蔬菜與水果的攝取，之後觀察病患營養攝取、體重變化及各種血液生化值變化情形。本研究共募集2 位受試者，在治療前後，分別以PG-SGA(patient-generated subjectiveglobal assessment)進行營養評估，收集受試者飲食紀錄、血液生化值、及血液促發炎激素分析。研究結果發現，經衛教後，在第一次追蹤時(衛教1週後)個案熱量及蛋白質攝取比例明顯提升，均可達建議量之80%以上，另外蔬果攝取量亦可達4-5 份/天(quecertin 含量約40-50 mg)。進入放射線治療後病患產生黏膜破損疼痛、口乾與咀嚼困難等現象，但無相關腸胃道症狀(腹瀉、腹脹、便秘)，噁心與嘔吐等現象亦輕微，個案1的熱量攝取降至約建議量之50-60%。 血漿中之TNF-α、IL-1β濃度於治療後，有下降情形，兩個個案於化療結束後口腔疼痛情形已逐漸改善，熱量攝取可達建議量之90%。本研究中兩位個案，在整個CCRT 療程內，體重流失僅約2-3 公斤。我們推論衛教促使病患在化放療治療期間，能有良好的熱量及蛋白質攝取，另外也增加富含quercetin 之蔬菜與水果攝取，這些可能有助於減少病患體重流失，並對CCRT 有良好的耐受。而這項觀察研究結果顯示，富含quercetin 之食物或補充劑對CCRT 治療的病患的健康可能有幫助。

Concurrent Chemo-Radiotherapy (CCRT) is a common treatment for patients with head and neck cancer. However, the side effects of the therapy including mucositis, swallowing problems, exrostomia, fatigue,pain, anorexia and nausea lead to poor appetite and then malnutrition.Malnutrition limits the treatment tolerance of patients and is associatedwith a poor prognosis. In this study, we implemented a nutrition education program for two head and neck cancer patients before they received CCRT. Nutrition education goals included: 1. increasing the patient''s energy and protein intake; and 2. increasing the intake of fruitsand vegetables rich in quercetin. We analyzed the changes in food intake, body weight and blood biochemical parameters. Before and after nutrition education/CCRT, the Patient-Generated Subjective Global Assessment (PG-SGA) was administered along with a 24-hour diet recall, a semi-quantitative food frequency questionnaire andcollection of blood biochemical parameters. The Results showed that protein and calorie intake increased and met 80% of the recommended amount a week after counseling the patients. Fruit and vegetable intake also increased to 4-5 portions/day (about 40-50mg quercetin/day). Sideeffects from therapy including oral mucositis, xerotosmia and difficulty swallowing (rather than nausea, constipation or diarrhea) were apparent three weeks after radiotherapy. The side effects caused a decrease in calorie intake to about 60% of the recommended amount in subject 1.Plasma levels of TNF-α and IL-1β did not markedly increase.Symptoms associated with oral inflammation ameliorated towards the end of therapy sessions and patients could reach 90% of their target 4 calorie goals. The total weight loss ranged from 2-3 kilograms after CCRT. We speculate that nutrition education improves a patient''s utritional status. It can further prevent weight-loss and increase patienttolerability of CCRT. Consumption of food rich in quercetin or a quercetin supplement may provide health benefits for cancer patients with CCRT