Impact of feeding tube choice on severe late dysphagia after definitive chemoradiotherapy for human papillomavirus–negative head and neck cancer

Ward, Matthew C.; Bhateja, Priyanka; Nwizu, T.; Kmiecik, Joann; Reddy, Chandana A.; Scharpf, Joseph; Lamarre, Eric; Burkey, Brian B.; Greskovich, J.F.; Adelstein, David J.; Koyfman, Shlomo A.

doi:10.1002/hed.24157

Cited by 23 publications

(29 citation statements)

References 37 publications

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“…[33][34][35][36][37] Studies have shown that prophylactic PEG can improve quality of life 38 and reduce the risk of aspiration, hospitalization, medical costs, 39 weight loss, length of stay, 40 and radiotherapy interruption rate. 47,48 A survey implied that 82.1% of doctors thought that prophylactic PEG was not necessary, but 88.1% agreed that nutritional consultation should be a routine step in the radiotherapy process. 42 Although PEG catheterization is more receptive than nasogastric tubes, studies [43][44][45] have also shown that PEG may result in a decrease in swallowing process.…”

Section: Discussionmentioning

confidence: 99%

Home enteral nutrition may prevent myelosuppression of patients with nasopharyngeal carcinoma treated by concurrent chemoradiotherapy

Zhou

Chu

et al. 2019

Head & Neck

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Background The aim of this study is to assess the effect of home enteral nutrition (HEN) on the myelosuppression of patients with nasopharyngeal cancer (NPC) during the course of concurrent chemoradiotherapy (CCRT). Methods A total of 18 outpatients with NPC administered oral nutritional supplementation intervention at home during the course of CCRT were designated as the HEN group, whereas 36 patients with NPC who had previously completed CCRT were retrospectively included as the control group. Patient Generated Subjective Global Assessment, body mass index (BMI), and blood test were evaluated prior to CCRT. During the course of CCRT, blood test was assessed every 2 weeks. Results In male patients, hemoglobin (HB) and red blood cell were decreased (P < .05) in both HEN and control group after CCRT, whereas white blood cell (WBC) started to decrease since week 2 of CCRT in the control group but maintained in the HEN group which was significantly higher than the control (5.05 ± 1.29 vs 3.77 ± 1.5, P < .05). In female patients, HB and WBC were reduced in control group during CCRT, whereas these indicators also maintained in the HEN group. Surprisingly, all patients with lower BMI (<24 kg/m2) had a significant increase in platelet (PLT) after CCRT (200.78 ± 58.03 vs 253.00 ± 69.82, P < .05), while had steady HB and WBC values in the HEN group. At the end of CCRT, WBC and PLT of the HEN group were both higher than those in the control group (5.21 ± 1.07 vs 3.37 ± 1.52), (253.00 ± 69.82 vs 165.57 ± 59.56) (P < .05 for both). Our findings suggest that HEN is effective in preventing myelosuppression during CCRT for patients with NPC. Conclusion Our findings suggest that HEN is effective in preventing myelosuppression during CCRT for patients with NPC.

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Section: Discussionmentioning

confidence: 99%

Home enteral nutrition may prevent myelosuppression of patients with nasopharyngeal carcinoma treated by concurrent chemoradiotherapy

Zhou

Chu

et al. 2019

Head & Neck

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“…Some toxicity could be prevented by reducing the amount of chemotherapy that these patients usually receive or omitting it completely. Furthermore, choice in feeding tube placed may also help address long term dysphagia that patients experience [21]. …”

Section: Discussionmentioning

confidence: 99%

Adjuvant Radiation Therapy Alone for HPV Related Oropharyngeal Cancers with High Risk Features

Liu

Miles

et al. 2016

PLoS ONE

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BackgroundCurrent standard of care for oropharyngeal cancers with positive surgical margins and/or extracapsular extension is adjuvant chemoradiotherapy. It is unknown whether HPV+ oropharyngeal cancer benefits from this treatment intensification.ObjectiveTo investigate the outcomes of HPV+ patients treated with adjuvant radiotherapy alone when chemoradiotherapy was indicated based on high risk pathological features. They were compared with high risk HPV+ patients treated with adjuvant chemoradiotherapy.MethodsAll high risk HPV+ oropharyngeal cancer patients (9) who received radiotherapy alone were identified. We also identified 17 patients who received chemoradiotherapy as a comparison group. Median follow up time was 37.3 months.ResultsNo local failures developed in adjuvant radiotherapy group. There was 1 distant recurrence in this cohort and 3 in CRT cohort. Regarding toxicity, 8 (47.1%) chemoradiotherapy patients had >10 lb. weight loss (p = 0.013), despite 75% of them having a percutaneous endoscopic gastrostomy tube placed. No individuals in radiotherapy group experienced a >10 lb. weight loss and none required a gastrostomy tube.ConclusionsThis series provides preliminary evidence suggesting that the omission of concurrent chemotherapy to adjuvant radiotherapy may offer comparative local control rates with a lower toxicity profile in the setting of HPV+ patients with traditional high risk features.

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“…There is, however, a great deal of variability in the reported incidence of these complications . More recently, several studies have reported that long‐term dysphagia may be associated with the use of a PEG tube . The authors hypothesized that, when compared with NGT, a PEG tube may cause a more pronounced atrophy of the muscles responsible for swallowing because of a prolonged absence of oral intake .…”

Section: Introductionmentioning

confidence: 99%

“…This hypothesis could be discussed because, although the patients with a PEG tube do not swallow enough food or liquids, they still swallow their saliva and liquids if they are able to. Most of these studies have been retrospective, and, therefore, subject to the flaws inherent in this type of study design and differences between the study and control groups include, for example, primary tumors, tumor stage, and the radiation volume and dose . Nevertheless, the conclusions from these studies have led to a restriction in the use of PEG tubes in several countries with the unfortunate consequence of potentially increasing the risk of malnutrition in these patients.…”

Section: Introductionmentioning

confidence: 99%

Effect of prophylactic percutaneous endoscopic gastrostomy tube on swallowing in advanced head and neck cancer: A randomized controlled study

et al. 2017

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Impact of feeding tube choice on severe late dysphagia after definitive chemoradiotherapy for human papillomavirus–negative head and neck cancer

Abstract: R-NG use during chemoradiotherapy is associated with less severe late dysphagia and is preferred over PEG. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1054-E1060, 2016.

Cited by 23 publications

References 37 publications

Home enteral nutrition may prevent myelosuppression of patients with nasopharyngeal carcinoma treated by concurrent chemoradiotherapy

Home enteral nutrition may prevent myelosuppression of patients with nasopharyngeal carcinoma treated by concurrent chemoradiotherapy

Adjuvant Radiation Therapy Alone for HPV Related Oropharyngeal Cancers with High Risk Features

Effect of prophylactic percutaneous endoscopic gastrostomy tube on swallowing in advanced head and neck cancer: A randomized controlled study

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