Nutritional needs are often neglected during and after radiation therapy. Malnutrition occurs not only due to the neoplastic disease itself but also due to the side-effects of radiation. This negatively affects the quality of life of the cancer survivor. In this context, the European Society on Clinical Nutrition and Metabolism guidelines for parenteral and enteral nutrition act as a guide for cancer caregivers detailing the general concepts, energy requirements, and interventions for nutrition of patients with cancer. Here is a poem about nutrition delineating the steps to mitigate the side- effects during and after radiation therapy.
Nutrition, nutrition, nutrition
Very important during radiation
Before radiation assessment
During radiation management
Post radiation surveillance
All are important guidance
Mixed causes of nutritional alteration
Local factors due to radiation
Concurrent chemo adds a vomiting sensation
Systemic factors due to tumorization
Mucositis, dysphagia, and aspiration
Xerostomia, dysgeusia in addition
Create a problem for nutrition
That happens during radiation
Ask the patient to drink water
Coughing is a sign to suffer
Coughing is a sign of aspiration
Needs the feeding tube insertion
Everyday weight measurement
It is the one-step nutrition management
Try to maintain a diet chart
It should be in the radiation cart
Patient needs a high-protein diet
No need to restrict fat or carbohydrate
Egg, nuts, paneer, chicken, and mutton
These are the high-protein nutrition
The role of glutamine is not sure
Some studies showed mucositis cure
Multivitamins and minerals
Not recommended more than allowances
When mucositis hinders the flow
To drink, best use a straw
Protein need is one g per kg per day
Energy is 30 calories per kg per day
There are various assessment tools
Any one is ok to keep you cool
Try to avoid parental nutrition
Nothing can replace enteral nutrition
Another factor is oral candidiasis
Needs antifungals to eradicate this crisis
Periodic gargling is required for hygiene
Try magic mouthwash or benzydamine
Soda salt gargle dissolves the sticky substance
Topical anesthetics have their own importance
Another sequel is electrolyte imbalance
Needed during and after radiation surveillance
Organs at risk and target hinder nutrition
Need extra care during their delineation
Keep the medial border of nodal contour medial to the carotid
Nodal contouring articles act here as the guide
Keep the upper border at C1 transverse in level 2 node
Unless you are treating the retropharyngeal node
When addressing the retropharyngeal node
Do not include the medial retropharyngeal node
Base of tongue, supraglottis, and constrictors
They are swallowing supporters
Parotid is not the only salivary target
Other salivary structures are not to forget
If you want to improve the nutrition
Try to improve plan optimization
Oral cavity, vocal cord, and post-cricoid
Please check the dose per volume (cc)
Still, there is value in a midline block
In 2-dimensional planning, try to use that block
Try to collapse the bridge between the vocal cord and post-cricoid
Important for non-laryngopharynx primary
Planning tumors of non-oral cavity
Avoid low-dose spillage over oral cavity
We should not be happy with intensity-modulated radiotherapy
Hope we will plan dose-optimized intensity-modulated radiotherapy
Take care of the nutrition during radiation
Weight loss forces adaptive radiation
Swallowing exercises during and after radiation
Demo videos give better visualization
Mendelsohn, Masako, and Shaker maneuvers
These exercises increase nutrition turnovers
Important post-radiation surveillance
Correct the fluid-electrolyte imbalance
Xerostomia and post-cricoid stenosis
These are the important late crises
Artificial saliva, pilocarpine, and stimulation
Some patients need endodilatation
Restrain yourself from giving more constraint
Otherwise tumor will sustain
Nutrition, nutrition, nutrition
Very important during radiation
Funding support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
