Prophylactic versus Elective PEG Tube Placement in Head and Neck Cancer

Abstract

Objectives:

1) Evaluate nutritional outcomes of head and neck cancer patients treated with prophylactic versus elective percutaneous endogastric (PEG) tubes. 2) Analyze the length of PEG tube usage when placed prophylactically versus electively.

Methods:

This is a retrospective review of 83 subjects treated with cisplatinum-based chemoradiotherapy (CRT) for head and neck cancer between 2007 and 2011, who received PEG tubes for nutritive support. Patients were eligible if their PEG tube was placed within six months of initiating CRT. Subjects were stratified according to when PEG tube placement occurred, whether before initiating CRT (prophylactic) or after (elective). Independent variables included age, gender, TNM stage, HPV tumor association, and CRT doses; outcome measures included weight change during radiation therapy, PEG tube duration, and survival.

Results:

Fifty-four patients received prophylactic PEG tubes, whereas 29 patients received elective PEG tubes. There was no significant difference in age, gender TNM stage, HPV tumor association, or CRT doses between the groups. Weight loss was not significantly different between the groups (-9.9% v. -10.0%, P = 0.96). Prophylactic patients had a longer duration of PEG tube usage than elective patients (mean 227 days v. 139 days, P < .01). Additionally, a higher percentage of elective patients were alive at last follow-up (100% v. 79.6%, P = .03).

Conclusions:

Patients requiring on-demand PEG tube placement may use their PEG tubes for a shorter duration than those receiving up-front placement, without suffering worse nutritional outcomes.