الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Worldwide, as the sixth most common cancer worldwide, head and neck cancer accounts for more than 650,000 cases and 330,000 deaths annually. In the United States, head and neck cancer accounts for 3 percent of malignancies, with approximately 53,000 Americans developing head and neck cancer annually and 10,800 dying from the disease
Patients with cancer are more likely to be malnourished than patients treated in many other specialties. Patients with head and neck cancer (HNC) are one of the most vulnerable groups to cancer-related malnutrition during, and after cancer treatment.
These tumors directly impact patients’ oral intake, taste, appetite, and intensify the effects of treatments toxicity increasing the risk of severe malnutrition, hardness, persistence of symptoms, and weight loss.
Moreover, antineoplastic treatments, like radiotherapy (RT) and chemotherapy (CT) or a combination of these (CRT), may also cause multiple symptoms that compromise oral intake.
The adverse effects of malnutrition on physical performance, quality of life (QoL) and cancer treatment tolerance and effect should be minimized by appropriate nutrition interventions.
Nutrition support therapy is appropriate in patients receiving active anticancer treatment who are malnourished and who are anticipated to be unable to ingest and/or absorb adequate nutrients for a prolonged period.
Use of specific substances for effects beyond their nutrition role is referred to as nutritional pharmacology. Four nutrients especially have been the subject of research: glutamine, arginine, nucleic acids, and essential fatty acids.
Glutamine is the most abundant amino acid in the blood and the free amino acid pool in the body. It is a nonessential amino acid in normal healthy individuals, as it can be produced in enough amounts in vivo and does not need to be supplied in the diet. Cells that utilize glutamine are immune competent cells, enterocytes, and hepatocytes.
Some studies have highlighted the use of oral glutamine supplementation to reverse cancer-related cachexia and other debilitating conditions. The clinical role of Glutamine in the prevention of CT and RT-induced toxicity is suggested. The effects were strongest when head and neck patients administrated intravenous glutamine.
Topical oral swish and swallow glutamine and a disaccharide, such as trehalose, has potential to ameliorate not only OM, but also esophagitis and enteritis after cancer chemotherapy and radiation.
Our study adopted intravenous glutamine to determine its effect on Radiotherapy related toxicities, Nutritional status, tumor response to treatment, radiotherapy interruptions due to toxicity, need for other interventions, rate of hospital admissions And Quality of life.
We found better grades of mucositis in patients received intravenous glutamine and better quality of life. Also, patients receiving glutamine had better nutritional status.
SO, L alanyl L glutamine nutritional supplement may have better results not only in nutritional status, but also in improving treatment tolerance and Quality of life.