Effects of Immunonutrition on Chemoradiotherapy Patients: A Systematic Review and Meta‐Analysis

Objective We conducted a systematic review to assess the effects of immunonutrition on chemoradiotherapy patients. Methods We searched the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, CINAHL, and the Web of Science. We assessed the risk of bias using the Cochrane Risk of Bias tool. Our primary outcomes were the incidence of oral mucositis and diarrhea. The secondary outcomes were the incidence of esophagitis, grade >= 3 oral mucositis, grade >= 3 diarrhea, grade >= 3 esophagitis, and body weight loss. Results A total of 1478 patients and 27 studies were included. There were no significant differences in the incidence of oral mucositis (relative risk [RR] = 0.91; 95% confidence interval [CI], 0.79-1.05), diarrhea (RR = 0.89; 95% CI, 0.76-1.05), or esophagitis (RR = 0.55; 95% CI, 0.11-2.86) between the immunonutrition group and standard nutrition/placebo group. Nevertheless, immunonutrition significantly reduced the incidence of grade >= 3 oral mucositis (RR = 0.45; 95% CI, 0.22-0.92), grade >= 3 diarrhea (RR = 0.56; 95% CI, 0.35-0.88), grade >= 3 esophagitis (RR = 0.15; 95% CI, 0.04-0.54), and losing >5% body weight (RR = 0.34; 95% CI, 0.18-0.64). Conclusions In this study, immunonutrition failed to reduce the incidence rates of oral mucositis, diarrhea, or esophagitis but was conducive to significantly improving the severity of oral mucositis and diarrhea esophagitis and reducing the rate of body weight loss.