Evaluating the Role of Prophylactic Gastrostomy Tube Placement Prior to Definitive Chemoradiotherapy for Head and Neck Cancer

Age Most Significant Predictor of Requiring Enteral Feeding in Head and Neck Cancer Patients

“…with enough team resources and a system in place to minimize breaks) the most compelling rationale for eschewing prophylactic tube placement might be avoidance of potential long-term physiologic consequences from disuse of the swallowing mechanism, especially with prolonged tube dependence. Several reports have raised the concern of objectively worse dysphagia and greater need for esophageal dilations in patients who undergo enteral feeding [8,[13][14][15]. In the Radiation Therapy Oncology Group (RTOG) 0129 study, 30% of patients were still tube-dependent at 1 year; in this large cohort, nearly 40% had their feeding tubes placed prophylactically [16].…”

“…This can be done with use of nasogastric tubes or more commonly, endoscopicallyplaced percutaneous tubes that bypass the proximal orodigestive tract and provide intake directly into the stomach or distally [7]. While tube placement typically carries low procedural risk, data suggest that enteral feeding can induce long-term tube dependence and disuse of the swallowing mechanism which has been linked to complications such as prolonged dysphagia and esophageal constriction [8].…”

Comparison of Treatment Compliance and Nutritional Outcomes among Patients with Nasopharyngeal Carcinoma with and without Percutaneous Endoscopic Gastrostomy during Chemoradiation

“…The PPEG insertion could reduce weight loss during radiation therapy. The weight losses were 8% from baseline in PPEG group and 14% from baseline in non-PPEG group (Chen et al, 2010). In Mercuri et al 'study, they conducted prospective non randomised study for evaluated effect of PPEG on the set-up variations in head and neck cancer patient.…”

“…Nourishment can be undertaken via percutaneous endoscopic gastrostomy and inserting the feeding tube to the stomach through the abdominal wall before radiation, called "prophylactic percutaneous endoscopic gastrostomy" (PPEG). PPEG has been effective in the maintenance of weight, reduced set-up error, reduced hospitalisation, reduced treatment interruption and improved quality of life (Lee et al, 1998;Chang et al, 2009;Mercuri et al, 2009;Salas et al, 2009;Chen et al, 2010;Assenat et al, 2011;Silander et al, 2011).…”

Optimising nutrition support in patients with head and neck cancer

“…Prophylactic gastrostomy tube (PGT) placement is a common method of nutrition support in patients with mucosal head and neck cancer (HNSCC), however there are concerns this leads to dysphagia and long term tube dependency (Chen et al, 2010;Corry et al, 2008;Langmore et al, 2012;Mekhail et al, 2001). Some studies have reported nil impact on swallowing function (Crombie et al, 2015;Silander et al, 2010), and the most recent systematic review on this topic remains inconclusive (Shaw et al, 2015).…”