The impact of nutritional status on treatment-related toxicities in children with embryonal brain tumors: The need for proactive nutritional management

Abstract

Background: Children on treatment for brain tumor are at high risk of malnutrition and have significant treatment-related toxicities. However, the impact of nutritional status on outcome and toxicity is not well understood. Aim: The objective of this study of children with embryonal brain tumor treated at our center was to understand the impact of nutritional status on treatment-related toxicities. Materials and Methods: We undertook this retrospective audit using a risk-stratified protocol between January 2017 and December 2018. Undernutrition was defined as severe or moderate malnutrition as per the World Health Organization (WHO) criteria. Nutritional status was assessed, and treatment-related toxicity (TRT) and survival rates were analyzed in relation to nutritional status at diagnosis and follow-up. Statistical Analysis Used: IBM SPSS for Windows, Version 24.0. Results: In the cohort of 72 patients with embryonal brain tumors, 64% were undernourished (UN) at the start of chemotherapy, and 2.7% were overweight. At the end of chemotherapy, 61% were UN. During the course of chemotherapy, weight gain was documented in 25% and weight loss in 23.8%. Although chemotherapy toxicity and infection were higher in UN children with medulloblastoma, this was not statistically significant. Both overweight children experienced TRT; one relapsed and subsequently died. Nutritional status did not affect survival rates. Conclusions: Children with embryonal brain tumor are at high nutritional risk, and undernutrition may worsen treatment-related toxicities. Proactive nutritional monitoring and intervention are needed in settings with a high prevalence of malnutrition and infections.