Effect of oral supplementation with immunonutrients on radiation-induced hematologic toxicity in cancer patients

Introduction

Radiation therapy in cancer patients causes hematologic abnormalities mainly attributed to an increased inflammatory state induced by radiation toxicity that are observed to be modulated by immunonutrition [1–3]. The objective of this study was to determine the effect of oral supplementation with immunonutrients on cancer patients undergoing radiation therapy on the following hematologic indices: hemoglobin, total WBC, neutrophil, lymphocyte, and platelet counts.

Methods

Cancer patients on radiotherapy from 2007 to 2009 were randomly assigned to a study group (n = 24), which received standard diet plus oral supplementation with an immunonutrition regimen (= 200 ml drink given twice per day providing 600 kcal, 40 g protein, eicosapentanoic acid = 2 g, antioxidants (Vit A = 600 μg, Vit C = 75.2 mg, Vit E = 15 mg, B-carotene = 1,500 μg)), and a control group (n = 32), which only had standard diet. The hematologic data - hemoglobin, total WBC count, neutrophil count, lymphocyte count, and platelet count - were taken before and after completion of the prescribed radiation dose. The results were analyzed using either paired or independent-samples t test.

Results

In the study group the blood indices were higher compared with the control group at the end of radiation therapy: hemoglobin in gm% (12.8 >11.8, P = 0.002), total WBC (7,276 >4,877, P = 0.0005), and neutrophil count (5,363 >3,315, P = 0.0007). There were no differences in the lymphocyte and platelet counts. The WBC change in the study group followed a decreasing pattern (-162.5) while in the control group it was an increasing pattern (+1,657). This indicated lesser inflammation in the study group while there was higher inflammation in the control group (P = 0.004).

Conclusions

Oral supplementation with immunonutrients in cancer patients undergoing radiation therapy resulted in lesser hematologic toxic changes in hemoglobin, total WBC, and neutrophil count.