Is nutrition support related to a poor prognosis in head and neck cancer patients? Thoughts about the secondary analysis of RTOG trial 90‐03

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

“…The authors concluded that although nutritional support and appropriate dietary intake benefited the host patient with respect to preserving body mass, minimizing toxicity to therapy, and improving quality of life, they seem ''to similarly benefit the malignancy as well.'' Although a subsequent editorial suggested that confounding factors may have influenced the conclusions that nutritional support has the potential to stimulate tumor growth, the data from RTOG 90-03 nonetheless forced many clinicians to question the role of dietary intervention in this setting (25).…”

Clinicopathologic and therapeutic risk factors for perioperative complications and prolonged hospital stay in free flap reconstruction of the head and neck

“…Moreover, identification of risk factors may offer an opportunity to modify a patient's risk of perioperative morbidity and prolonged hospitalization preoperatively. Although, this has been studied in patients undergoing head and neck cancer resection by several authors, [19][20][21][22] there is limited data examining patients undergoing free flap reconstructive surgery. Furthermore, free flap reconstructive surgery is generally more complex than non-free flap head and neck surgery.…”

“…19 This is not surprising, since more than 75% of patients over the age of 70 years have 1 or more medical problems, and perioperative morbidity and mortality are more common in elderly patients. 22,34 Hesitancy about the safety of anesthesia and surgery in elderly patients is further compounded by concerns regarding the consequences of free flap failure and the need for reoperation. 35 Evidence that age has an independent impact on outcomes in this patient population is equivocal, since most reports are limited by the number of patients studied, treatment bias resulting in avoidance of free tissue transfer in elderly patients, and by lack of control of confounding factors such as comorbidity.…”

Prophylactic Percutaneous Endoscopic Gastrostomy Tube Placement in Treatment of Head and Neck Cancer

“…A study conducted by Rabinovitch et al 126 is worth singling out; it is the largest study to date evaluating nutrition data in HNC patients treated in RTOG 90-03 and has generated some controversy. 127 The authors examined whether patients who were enrolled in a prospective RCT evaluating 1 of 4 definitive chemoradiation fraction schedules received nutrition support before, during, or after treatment and the associated outcomes. Of 1,073 patients, 293 received nutrition support before treatment.…”