br The present study showed that the continuation of S
The present study showed that the continuation of S-1 adjuvant chemotherapy in the Elental® treatment group was significantly higher than in the control group and that oral mucositis was a significant risk factor for continuation of S-1 adjuvant chemotherapy. There are several limitations in our study. First, it Coelenterazine was a single-institutional study with a small sample size. Second, we did not exclude patients who experienced recurrence within 12 months after surgery. However, we think that
Elental® treatment can aﬀect the continuation of S-1 adjuvant che-motherapy, for several reasons.
Severity of neutropenia has been associated with the incidence and severity of chemotherapy-induced oral mucositis . Ogata et al. demonstrated that the severity of oral mucositis tended to increase with the severity of neutropenia . This study encourages us to speculate on whether nutritional intervention could also improve neutropenia.
Body weight loss was the second strongest risk factor for con-tinuation of S-1 adjuvant chemotherapy even though it was not sig-nificant in the present study. Aoyama et al. showed that body weight loss of 15% or higher was associated with significantly lower S-1 compliance in patients with gastric cancer, and reasons for withdrawal were anorexia and fatigue . Ryu et al. found that postoperative body weight loss was significantly greater in malnourished patients than in well-nourished patients . Therefore, body weight loss was found to closely correlate with a decline in postoperative quality of life and could be one indicator of malnutrition. A decrease in physiological function might aﬀect compliance with S-1 chemotherapy, although the precise mechanisms are still unknown. One of the limitations of our study was the small sample size studied at a single site. Hence, we are currently conducting a large, multicenter study to confirm the bene-ficial eﬀects of Elental® on adjuvant chemotherapy induced oral mu-cositis in gastric cancer patients.
We conclude that the amino-acid rich elemental diet Elental may be useful as a countermeasure for S-1 adjuvant chemotherapy-associated mucositis. It could aﬀect continuation of S-1 adjuvant chemotherapy in patients with advanced gastric cancer. Further prospective multicenter clinical trial must be needed to confirm the benefits indicated from template strand prospective single-center study.
No conflicts of interest to disclose.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Appendix A. Supplementary data
Supplementary data to this article can be found online at https://
Univariate and multivariate Cox proportional hazards analyses of clinical factors for S-1 continuation.
Clinical factors No.
HR 95%CI P value HR 95%CI P value
Performance status (ECOG)
Type of gastrectomy
Body weight loss
Stage of disease
Incidence of grade 2 adverse events.
Grade 1 Grade 2 Grade 1 Grade 2
1 Anorexia 2
Elevated ALT 1 1
1 General fatigue 1
et al., Risk factors for poor compliance with adjuvant S-1 chemotherapy for gastric
 Y. Tanaka, T. Takahashi, K. Yamaguchi, S. Osada, T. Shimokawa, K. Yoshida, Elemental diet plus glutamine for the prevention of mucositis in esophageal cancer patients receiving chemotherapy: a feasibility study, Support. Care Canc. 24 (2) (2016) 933–941.