Oral glutamine supplements reduce concurrent chemoradiotherapy-induced esophagitis in patients with advanced non-small cell lung cancer.

Medicine. 2019;98(8):e14463

Plain language summary

Non-small cell lung cancer (NSCLC) is commonly treated with concurrent chemo- and radiation therapy (CCRT). This treatment often causes acute radiation-induced oesophagitis (ARIE) which can lead to significant weight loss and unplanned treatment delays. This prospective randomised study assessed whether glutamine supplementation may prevent ARIE in advanced NSCLC patients. Patients were randomised to receive either standard treatment (CCRT) with prophylactic oral glutamine, 30 grams/day, or standard treatment alone. The patients in the glutamine group received glutamine for 1 year. Compared with the control group, the oral glutamine supplement group had significantly less severe ARIE, and in those patients who developed ARIE, onset was significantly delayed in the glutamine group. The incidence of weight loss was also significantly reduced in the glutamine group. There was no statistically significant difference in cancer progression-free survival between the two groups (median follow-up period 26.4 months). Glutamine supplementation was well tolerated by all patients. The authors conclude that oral glutamine supplementation has a benefit in delaying onset of and decreasing the severity of ARIE in advanced lung cancer patients undergoing CCRT.


BACKGROUND Complications related to concurrent chemoradiotherapy (CCRT) such as acute radiation-induced esophagitis (ARIE) may cause significant morbidity and unplanned treatment delays in patients with advanced non-small cell lung cancer (NSCLC). We designed a prospective randomized study to assess the impact of glutamine (GLN) supplementation in preventing CCRT-induced toxicities of advanced NSCLC patients. METHODS From September 2014 to September 2015, 60 patients diagnosed with NSCLC were included to the study. Thirty patients (50%) received prophylactic powdered GLN orally at a dose of 10 g/8 h. The prescribed radiation dose to the planning target volume was 30 Gy in 2-Gy fractions. The endpoints were radiation-induced esophagitis, mucositis, body weight loss, overall survival and progression-free survival. RESULTS The 60 patients with NSCLC included 42 men and 18 women with a mean age ± standard deviation of 60.3 years ± 18.2 (range, 44-78 years).At a median follow-up of 26.4 months (range 10.4-32.2), all patients tolerated GLN well. A administration of GLN was associated with a decrease in the incidence of grade 2 or 3 ARIE (6.7% vs 53.4% for Gln+ vs Gln-; P = .004). GLN supplementation appeared to significantly delay ARIE onset for 5.8 days (18.2 days vs 12.4 days; P = .027) and reduced incidence of weight loss (20% vs 73.3%; P = .01). DISCUSSION Our study suggests a beneficial effect of oral glutamine supplementation for the prevention from radiation-induced injury and body weight loss in advanced NSCLC patients who receiving CCRT.

Lifestyle medicine

Patient Centred Factors : Mediators/Radiotherapy
Environmental Inputs : Nutrients ; Radiation
Personal Lifestyle Factors : Not applicable
Functional Laboratory Testing : Not applicable
Bioactive Substances : Glutamine ; Chemotherapy ; Radiotherapy

Methodological quality

Jadad score : 2
Allocation concealment : Not applicable


Nutrition Evidence keywords : Weight loss