Percutaneous feeding tubes in patients with head and neck cancer: rethinking prophylactic placement for patients undergoing chemoradiation

Lawson, Joshua D.; Gaultney, J; Saba, Nabil F.; Grist, William; Davis, Lawrence W.; Johnstone, Peter A.S.

doi:10.1016/j.amjoto.2008.06.010

Cited by 35 publications

(24 citation statements)

References 29 publications

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“…However, the major concern on the early PEG-tube could delay the transition to oral nutrition which may lead swallowing muscles disuse protraction [18,19]. Since high doses to the pharyngeal constructor muscles increase the incidence of long term impaired swallowing [30], early insertion may exacerbate the incidence of pharyngeal stenosis and swallowing impairment after curative radiation.…”

Section: Discussionmentioning

confidence: 99%

“…Salas et al [17] reported in their prospective randomized study that prophylactic PEG-tube insertion and early feeding also improves the QoL of LAHNC patients. However, there are still some concerns and uncertainties for early tube insertion, such as tube-related side effects, delaying the transition to oral nutrition and lack of objective parameters for tube removal decision [18,19].…”

Section: Introductionmentioning

confidence: 99%

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The impact of early percutaneous endoscopic gastrostomy placement on treatment completeness and nutritional status in locally advanced head and neck cancer patients receiving chemoradiotherapy

Atasoy

Yönal

Demirel

et al. 2011

Eur Arch Otorhinolaryngol

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To investigate the impact of early insertion of percutaneous endoscopic gastrostomy-tube on nutritional status and completeness of concurrent chemotherapy in locally advanced head and neck cancer patients treated with chemoradiotherapy. Twenty-three patients were enrolled into this prospective study. Gastrostomy-tube was inserted in patients before the initiation of chemoradiotherapy. There was not any significant change in nutritional parameters of patients that used their tube during treatment. Despite the grade 3 mucositis, the planned concurrent chemotherapy could be given in 70% of the patients. However, nine patients had weak compliance and their body weight (P = 0.01) and body mass index (P = 0.01) deteriorated in the first 4 weeks of chemoradiotherapy. The completeness of concurrent chemo-rate was 44% in these patients. Toxicity, requiring aggressive supportive care, may limit the chemotherapy part of curative concomitant chemoradiotherapy. By providing adequate enteral nutrition the insertion of gastrostomy-tube can increase the completeness rate of concurrent chemotherapy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The impact of early percutaneous endoscopic gastrostomy placement on treatment completeness and nutritional status in locally advanced head and neck cancer patients receiving chemoradiotherapy

Atasoy

Yönal

Demirel

et al. 2011

Eur Arch Otorhinolaryngol

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“…[1][2][3][4][5] However, the placement of a prophylactic PEG tube carries measurable risks, most notably an infection rate of 5% to 8%, along with diarrhea, constipation, electrolyte abnormalities, gastrointestinal bleeding, a clogged lumen and tube replacement, and metastatic seeding at the gastrostomy site. [4][5][6][7] In addition, some groups have suggested that avoidance of PEG tube placement during therapy may be associated with a lower risk of long-term dysphagia outcomes such as PEG tube dependence or pharyngoesophageal stricture. [8][9][10] Therefore, our objective was to assess potential risk factors leading to the reactive placement of a PEG tube in patients undergoing concurrent CRT for oropharyngeal squamous cell carcinoma.…”

mentioning

confidence: 99%

Risk Factors for Percutaneous Endoscopic Gastrostomy Tube Placement During Chemoradiotherapy for Oropharyngeal Cancer

Ström

Trotti

Kish

et al. 2013

JAMA Otolaryngol Head Neck Surg

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IMPORTANCEPatients with oropharyngeal squamous cell carcinoma undergoing chemoradiotherapy may require percutaneous endoscopic gastrostomy (PEG) tube placement because of dehydration or significant weight loss.OBJECTIVES To determine the need for the reactive placement of a PEG tube during chemoradiotherapy for oropharyngeal cancer and to identify patient or tumor factors associated with reactively requiring the placement of a PEG tube. MAIN OUTCOMES AND MEASURESLogistic regression analysis was used to identify independent risk factors associated with symptomatic requirement for the reactive placement of a PEG tube. RESULTSIn total, 128 patients did not receive a prophylactic PEG tube within 10 days of initiation of chemoradiotherapy. Fifteen of 128 patients (11.7%) required the reactive placement of a PEG tube during or within 3 months of chemoradiotherapy. The median time to PEG tube removal was 3.3 months, and 14 of 15 patients had their PEG tube removed at the last follow-up analysis. Independent risk factors for PEG tube placement included the following: accelerated irradiation fractionation (odds ratio, 4.3; 95% CI, 1.1-16.5; P = .04), a tumor T classification of 3 or higher (odds ratio, 3.5; 95% CI, 1.0-11.9; P = .04), a cumulative cisplatin dose of 200 mg/m 2 or higher (odds ratio, 6.7; 95% CI, 1.2-36.7; P = .03), and a body mass index (calculated as weight in kilograms divided by height in meters squared) of less than 25 (odds ratio, 5.8; 95% CI, 1.4-23.9; P = .02).CONCLUSIONS AND RELEVANCE Although the overall risk is low, a body mass index of less than 25, accelerated irradiation fractionation, a tumor T classification of 3 or higher, and a cumulative cisplatin dose of 200 mg/m 2 or higher are associated with symptomatic need for the reactive placement of a PEG tube in patients with oropharyngeal cancer.

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“…A gastrostomy tube is preferred if anticipated duration of nutrition support is likely to be greater than four weeks (Arends et al, 2006). Historically, many centres favoured the proPEG method, however there has been a trend in recent times to move away from this approach and favour reactive management with an NGT (Clavel et al, 2011;Lawson et al, 2009;Madhoun, Blankenship, Blankenship, Krempl, & Tierney, 2011).…”

Section: Tube Feeding: Optimal Type and Timingmentioning

confidence: 99%

“…Several studies document the predictive factors for long term tube feeding, or gastrostomy dependency, such as tumour sites (Caudell et al, 2010;Ishiki et al, 2012), tumour stage (Akst et al, 2004;Avery et al, 2008;Gokhale et al, 2010;Kornguth et al, 2005;Lawson et al, 2009), treatment modality (Avery et al, 2008;Kornguth et al, 2005;Lango et al, 2010), radiotherapy treatment fields and dose (Caudell et al, 2010;Gokhale et al, 2010;Li et al, 2009;Sanguineti et al, 2011), smoking (Li et al, 2009), age (Kornguth et al, 2005;Lango et al, 2010;Lawson et al, 2009), and pre-treatment weight loss or low body mass index (BMI) (Lango et al, 2010;McRackan et al, 2008). These types of clinical factors are often considered for the prediction of patients who may benefit from PGT placement (Brown et al, 2013b;Jack et al, 2012;Wood, 2005), as they are anticipated to require a feeding tube for longer than four weeks and thus a gastrostomy is the most suitable long term feeding device (Arends et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Optimising nutrition support in patients with head and neck cancer

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Percutaneous feeding tubes in patients with head and neck cancer: rethinking prophylactic placement for patients undergoing chemoradiation

Cited by 35 publications

References 29 publications

The impact of early percutaneous endoscopic gastrostomy placement on treatment completeness and nutritional status in locally advanced head and neck cancer patients receiving chemoradiotherapy

The impact of early percutaneous endoscopic gastrostomy placement on treatment completeness and nutritional status in locally advanced head and neck cancer patients receiving chemoradiotherapy

Risk Factors for Percutaneous Endoscopic Gastrostomy Tube Placement During Chemoradiotherapy for Oropharyngeal Cancer

Optimising nutrition support in patients with head and neck cancer

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