Effects of parenteral nutrition on the immune system in patients with head and neck squamous cell carcinoma

Oncologic patients often face malnutrition, particularly in the case of head and neck squamous cell carcinoma(HNSCC), due to the site of the lesion that may hinder swallowing. Malnutrition is associated with immunosuppression and increased incidence of infections and mortality, and improving the nutritional status with support regimes, such as parenteral nutrition (PN) can restore immune competence.The bags destined for PN contain mostly lipids and are enriched with essential fatty acids, specifically polyunsaturated fatty acids (PUFAs) ω3 and ω6. It is now clear that lipids, including PUFAs, influence the immune system: ω3 have an anti-inflammatory effect, thus repressing the immune response, whereas ω6 promote Th1-like responses.Although current guidelines suggest caution in the use lipid emulsions of ω6 in patients with uncontrolled inflammatory responses, such as those underlying autoimmune diseases, these may instead be advisable in patients unable to develop an adequate antitumoral response.Thegoal of clinical research is the personalization of therapies which include supportive therapies, such as nutritional support. It is indeed possible to predict that, in the near future, the individualized choice of specific nutrients could allow the patient not only to deal with chemotherapy with less toxicity, but also to promote advantageous immune responses and, therefore, survival.