Goal-directed nutritional support in preserving muscle mass and optimising recovery in treatment of oesophageal cancer: results of a prospective non-randomised cluster trial
In brief
Goal-directed nutrition does not curb muscle loss or improve survival
In a prospective cluster trial of 100 esophageal cancer patients, a goal-directed nutritional support protocol produced a slightly smaller decline in muscle index during treatment than usual care (about 0.7% difference), but the difference was not statistically significant and one-year overall and disease-free survival were identical. The results suggest that more intensive, personalized interventions are needed, especially after surgery.
- Journal
- Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (Q1)
- Published
- 3 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Iris Barth, Iris Stelwagen, Linda B M Weerink, Dorienke Gort-van Dijk, Hanna Meinders, Milos Milovanovic, et al.
- PMID
- 42693322
- DOI
- 10.1007/s00520-026-11153-4
Why clinicians should know about it
- Picked for Rehabilitation (top studies of the week, 6 September 2026): Nutritional support in oesophageal cancer, not rehab focus
Abstract
PURPOSE: Oesophageal cancer (OEC) treated with neoadjuvant chemoradiotherapy (CRT) followed by oesophagectomy is associated with muscle loss and impaired recovery. We aim to evaluate whether a goal-directed nutritional support protocol (GDNS) is associated with muscle loss and improved survival after CRT and oesophagectomy compared with usual care. METHODS: Adults with OEC undergoing CRT and oesophagectomy were included. In this trial, a tertiary centre provided GDNS, and a secondary hospital offered usual care. Changes in appendicular skeletal muscle index (ASMI) were assessed during CRT and up to 12 months postoperatively using bioelectrical impedance analysis. One-year overall and disease-free survival were investigated. RESULTS: GDNS and usual care each included 50 patients. Between baseline and CRT completion, ASMI declined in GDNS (-2.53 ± 3.43%) and usual care (-3.20 ± 6.92%, P = 0.559), recovered between CRT completion and preoperatively (0.95 ± 4.33 vs 2.51 ± 7.95%; P = 0.368; respectively), and declined 12-months postoperatively (-5.75 ± 4.75% vs -7.09 ± 7.38%; P = 0.598; respectively). Results remained non- significant after adjustment for confounders and time × group interaction. Survival did not differ between groups. CONCLUSION: In both GDNS and usual care, ASMI declines during CRT, recovers after, and decreases postoperatively. The magnitude of ASMI loss is smaller with GDNS than with usual care, although not statistically significant. Survival does not differ between groups. Our findings underscore the need for personalised, integrated interventions to optimise recovery, particularly in the postoperative phase.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.