Nutritional support in children treated for advanced adrenocortical carcinoma
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In brief
In brief
This retrospective study examines nutritional support needs in pediatric patients with advanced adrenocortical carcinoma undergoing multimodal chemotherapy. Over half of patients required enteral or parenteral nutrition due to treatment-related gastrointestinal toxicity, with younger children at higher risk. The authors recommend considering preemptive feeding tube placement to prevent treatment delays.
- 54.5% of pediatric patients with advanced ACC required supplemental nutrition (enteral or parenteral) during multimodal chemotherapy treatment.
- Patients needing nutritional support experienced mean weight loss of 13.8% and required support for average 362 days during treatment course.
- Younger patients (mean age 4.45 vs 9.14 years) were more likely to require nutritional supplementation during ACC treatment.
- Preemptive feeding tube placement should be considered in advanced ACC patients to prevent treatment delays from poor oral intake.
- Cisplatin-based chemotherapy regimens for ACC cause significant GI toxicity that frequently prevents adequate oral nutrition intake.
Written by the GCMD Library team from the article.
Abstract
Purpose
Adrenocortical carcinoma (ACC) is a rare, aggressive pediatric malignancy. Advanced ACC requires multimodal treatment, including surgery and systemic chemotherapy including cisplatin, etoposide, doxorubicin, and mitotane. This is associated with significant gastrointestinal toxicity, resulting in many patients being unable to complete scheduled therapy. Often, supplemental nutrition is required if oral intake during treatment is poor. We assessed the frequency of nutritional supplement use in pediatric patients treated for advanced ACC.
Methods
This was a retrospective observational study of patients with ACC treated at St. Jude Children’s Research Hospital over 10 years (2012–2022). Patient demographics, treatment received, and the need for supplemental enteral or parenteral nutrition were reviewed.
Results
A total of 18 patients with ACC were treated from 2012 to 2022, with 11 having advanced ACC. 54.5% of patients required supplemental nutrition, both enteral and parenteral. All patients requiring supplemental nutrition were intolerant of oral intake, with a mean weight loss of 13.8% (range: 5.9–35%). Mean duration of nutritional support was 362 ± 337 days. Patients requiring supplemental nutrition tended to be younger than others (mean age: 4.45 ± 3.63 vs. 9.14 ± 4.59 years; median age: 3.35 vs. 8.40 years; range: 0.90–11.0 vs. 3.30–15.1 years) (p = 0.082).
Conclusions
Most patients with stage IV ACC require nutritional support during their treatment course, especially younger patients. Preemptive feeding tube placement should be considered to avoid delays in treatment.