Systematic percutaneous fluoroscopic gastrostomy for concomitant radiochemotherapy of advanced head and neck cancer: optimization of therapy

Abstract

Wasting is a major complication of advanced head and neck cancer. Concomitant chemotherapy and twice-daily continuous radiotherapy with no acceleration represents a promising treatment modality for these tumors, but increases the risk of mucositis. This report describes the results achieved with percutaneous fluoroscopic gastrostomy (PFG) and its impact on the quality of life of patients with head and neck cancer in terms of their nutritional status. A total of 50 stage IV tumors of the oropharynx and hypopharynx recorded in a prospective database were reviewed retrospectively. All patients were managed by PFG, which was found to be a safe and effective technique with no technical failures. PFG feeding resulted in a mean increase in body weight of 2.5 kg within 3 weeks. The body mass index (BMI) was maintained at 3 and 6 weeks. Minor complications occurred, but no major complications were noted. The overall procedure-related mortality rate was nil. Further prospective investigations are necessary to determine whether treatment of wasting improves patient survival.

Nutritional support in patients with oesophageal cancer

“…In one prospective [9] and several retrospective [18,32,50,87] TF was shown to significantly reduce weight loss compared with normal oral alimentation, also when RT was combined with chemotherapy [60]. As a consequence, quality of life could be maintained [86], interruptions of treatment could be prevented [23,86] and frequency of hospital admissions could be reduced [23,48].…”

Optimising nutrition support in patients with head and neck cancer

“…Some studies have reported on commencement of enteral feeds prior to treatment (Beer et al, 2005;Marcy et al, 2000;Nguyen et al, 2006;Wiggenraad et al, 2007) however these study designs are quite different to our proposal, with their patients often having a poor nutritional status or dysphagia at baseline therefore requiring immediate or therapeutic nutrition support, in comparison to our target population being primarily wellnourished with minimal dysphagia.…”

“…There have been two other studies which have looked at initiating tube feeding immediately following prophylactic placement (Beer et al, 2005;Marcy et al, 2000). Both of these studies also had a significant proportion of patients who were nutritionally compromised at baseline and therefore the characteristics of the patients commencing early nutrition support are likely to be quite different to the patient characteristics we are anticipating studying.…”

“…There have been no studies in the literature to date that have investigated additional pre-treatment nutrition interventions in comparison to standard best practice care models of regular dietitian care during and post-treatment. Current studies which use proPEG tubes and report on the timing of commencement of nutrition support, do so when clinically indicated in response to deterioration in swallowing or nutritional status (Beer, Krause, Zuercher, & Stanga, 2005;Marcy et al, 2000;Nguyen et al, 2006;Nugent et al, 2010a;Raykher et al, 2009;Scolapio, Spangler, Romano, McLaughlin, & Salassa, 2001;Wiggenraad et al, 2007). A range of outcomes following the theoretical model will be assessed from this intervention study: clinical outcomes (weight, body composition, nutritional status, and treatment tolerance); cost outcomes (unplanned admissions); and patient outcomes (survival and QOL).…”

“…Some studies have reported the commencement of enteral feeds prior to treatment (Nguyen et al, 2006, Wiggenraad et al, 2007, Marcy et al, 2000, Beer et al, 2005 but these patients had poor nutritional status or dysphagia at baseline and therefore nutrition support was clinically indicated immediately.…”