Nutrition Management of Patients With Neoplastic Disease of the Head and Neck Treated With Radiation Therapy

Abstract

Neoplastic lesions of the head and neck are primarily squamous cell carcinomas of the aerodigestive tract mucosa. Approximately 43,000 new cases of head and neck cancer (8.5% of all malignancies) are diagnosed in the United States each year. Tumors, with a male predominance at age 50 to 60 years, generally occur on the surface of the mucosal lining of the oral cavity, oropharynx, nasopharynx, larynx, maxillary sinus, salivary glands, and the thyroid gland. Tobacco, alcohol, and the combination of tobacco and alcohol are the principle causative agents of head and neck neoplasms. The use of these carcinogenic agents often has a negative impact on lifestyle, and it is not unusual for significant nutritional deficiencies to exist in this population before diagnosis of head and neck cancer. Definitive and adjuvant cancer treatment modalities are rigorous, and sequelae associated with the therapy often further impair nutritional status and increase morbidity. Auspicious nutrition assessment and management before the initiation of therapy can have a significant impact on the course of treatment and the patient's quality of life.

Evaluation of Nutritional Status in Cancer Patients Receiving Radiotherapy

“…RT to the head/neck may cause anorexia, changes in taste, dry mouth, inflammation of the mouth, swallowing problems, cavities, and infection. 21 Thoracic irradiation may cause inflammation of the esophageal mucosa, esophageal reflux, nausea, and vomiting. 22 Abdominal or pelvic RT may cause nausea and vomiting or acute radiation enteritis.…”

Prophylactic Gastrostomy Tubes in Patients Undergoing Intensive Irradiation for Cancer of the Head and Neck

“…24 Furthermore,patientdiscomfort,poorer cosmesis, risk of aspiration or sinusitis, greater frequency of occlusion, and effects of local irritation to irradiated mucosa make nasogastric tubes less attractive for head and neck cancer patients undergoing radiotherapy. 25,26 Gastrostomy tubes can be used either prophylactically or therapeutically via an endoscopic 13,14 or radiologically guided 27 approach. These are indicated for longterm nutritional supplementation when oral intake is inadequate secondary to either the local effects of tumor or toxic effects from treatment.…”

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

“…42 The use of PEG tubes is specifically recommended for HNC patients by several groups of leading HNC researchers and clinicians because radiation therapy typically requires 6 to 8 weeks. [43][44][45][46][47] PEG tubes result in fewer complications compared with either radiologic or surgical insertion techniques in HNC patients and are the first method of choice in these patients. 46,48 PEG tubes were introduced in 1980 as an alternative to an open procedure for surgical gastrostomy for long-term feeding in patients unable to take food by mouth.…”