Imunonutrição em câncer de cabeça e pescoço: efeitos clínicos e nutricionais

Abstract

The expression head and neck cancer (HNC) refers to a group of neoplasms that may be present in the oral cavity, pharynx, larynx, nasal cavity, paranasal sinuses, thyroid and salivary glands that include a variety of histopathological tumors. Among the treatment options, there are surgery, radiation and / or chemotherapy, with surgery being the main one. However, depending on the tumor site and the disease stage, surgical resection can compromise important functions; thus, radiotherapy and chemotherapy appear as alternatives in the treatment. Malnourished patients have a worse prognosis and impaired immune function. Regarding the immune function, it has gained a significant role in cancer and this importance has given rise to a research field, which included the study of specific nutrients, capable of modulating the actions of the immune system and of influencing clinical outcome, known as immunonutrition. The triad glutamine, arginine and omega 3 has received a great focus in surgical patients, being related to a lower number of postoperative complications, increased survival, and body weight recovery. However, studies during chemoradiotherapy are still limited in this population. In order to contribute to the problem discussion, this dissertation is divided into two topics: The first one is a literature review, adressing the main points related to the HNC, the role of the immune system in cancer and aspects related to immunonutrition, focusing on the immunonutrients arginine, glutamine and omega 3. The second topic refers to a systematic review with meta-analysis that assessed the effects of glutamine, arginine and omega 3 supplementation on treatment tolerance, nutritional status and immune function in HNC during chemoradiotherapy. It was shown that glutamine can act on the severity of mucositis during chemoradiotherapy and that omega 3 can be promising in recovering nutritional status. However, results for immune function were limited. These results must be interpreted with care, given the differences between the supplementation regimen and the lack of methodological rigor in an important portion of the studies. Investigations focused on elucidating the contribution of each immunonutrient during chemoradiotherapy deserve further investigation.