Riesgos de la NP

4.1 ¿Puede la NP “alimentar” al tumor?

Probablemente sí.

Aunque la NP suministra nutrientes al tumor, no hay evidencia de que ello tenga efectos nocivos sobre los resultados del tratamiento.

Por esto, esta consideración no debe influir sobre la decisión de alimentar a un paciente con cáncer cuando está indicada la NP (Grado C).

Comentarios:

La mayoría de los estudios que investigan la relación entre NP y crecimiento tumoral se han efectuado en modelos animales con tumor.

Por lo mismo, hay diversas razones para no trasladar los resultados de NP en tumores experimentales al terreno de los seres humanos. La relación proporcional entre el tamaño del tumor y el tamaño del organismo afectado es de 10 a 20% en los tumores experimentales, pero en los seres humanos muy raramente sube del 1%.

Generalmente, los animales con tumor reciben alimentación durante 1 a 2 semanas, por lo que el período de nutrición artificial cubre cerca de las dos terceras partes de la historia natural de su enfermedad.

La citocinética de los tumores experimentales generalmente es muy diferente de lo que se observa en tumores humanos y más rápida.

Una revisión de la literatura en las bases PubMed y EMBASE permitió identificar doce trabajos adecuados( 155-166) que abarcan un total de 140 pacientes que recibieron soporte nutricional y 84 controles.

Los estudios se clasificaron como ensayos clínicos aleatorizados en cinco casos, ensayos comparativos clínicos no aleatorizados en tres ocasiones y ensayos con pacientes que eran sus propios controles en 4 casos.

Los diversos indicadores de aumento en la producción de células tumorales que se usaron en los estudios incluyen el índice de ADN, la actividad de la ornitina decarboxilasa, la distribución de ADN en citometría de flujo y el índice de marcación con timidina tritiada o bromodeoxiuridina.

No se observó aumento en la producción de células tumorales en los pacientes de control que recibieron la dieta usual, pero sí, en siete de los 12 estudios en los pacientes que recibían soporte nutricional.

Sin embargo, no hay datos suficientes en la literatura para aclarar si esa promoción del metabolismo tumoral fue desproporcionadamente alta en comparación con el estímulo sobre las otras células corporales; tampoco se informaron efectos clínicos perjudiciales de la NP sobre el crecimiento tumoral cuando el soporte nutricional se les dio a pacientes que estaban afágicos y desnutridos.

En conclusión, el temor de un crecimiento desproporcionado y excesivo del tumor(167) no debe permitir que se les niegue soporte nutricional adecuado a pacientes con cáncer si dicho soporte tiene indicaciones clínicas.

Conflicto de intereses

Los conflictos de intereses se hallan debidamente registrados en los archivos de ESPEN (espenjournals@ espen.org).

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