To understand the impact of percutaneous endoscopic gastrostomy (PEG) tube placement timing on tube duration, weight loss, and disease control in patients with head and neck cancer (HNC).
Setting
A tertiary academic center.
Study Design
Historical cohort study.
Subjects and Methods
Seventy-four patients with HNC were reviewed. Patients underwent cisplatinum-based chemoradiation therapy with or without surgical resection. They received a PEG tube either before radiation therapy began (prophylactic) or after (reactive). Patients were matched on the basis of age, gender, TNM stage, tumor subsite, human papillomavirus (HPV) status, and chemoradiation dose.
Results
Patients receiving reactive PEG tubes had them in place for fewer days than those placed prophylactically (227 vs 139 days, P < .01). There was no difference in percentage weight loss at 2, 6, or 12 months. There was no difference in survival or disease control between the groups.
Conclusions
Reactive PEG tube placement may afford patients a shorter duration of usage without incurring greater weight loss or poorer oncologic outcomes.
SiegelRNaishadhamDJemalA. Cancer statistics, 2013. CA Cancer J Clin. 2013;63:11-30.
2.
Martin VillaresCSan Roman CarbajoJFernandez PelloMETapia RisuenoMDominguez CalvoJ. [Nutritional status in head and neck cancer patients: the impact on the prognoses]. Nutr Hosp. 2003;18:91-94.
3.
LeesJ. Incidence of weight loss in head and neck cancer patients on commencing radiotherapy treatment at a regional oncology centre. Eur J Cancer Care. 1999;8:133-136.
4.
LocherJLBonnerJACarrollWR. Patterns of prophylactic gastrostomy tube placement in head and neck cancer patients: a consideration of the significance of social support and practice variation. Laryngoscope. 2013;123:1918-1925.
5.
NguyenNPNorthDSmithHJ. Safety and effectiveness of prophylactic gastrostomy tubes for head and neck cancer patients undergoing chemoradiation. Surg Oncol. 2006;15:199-203.
6.
RaykherACorreaLRussoL. The role of pretreatment percutaneous endoscopic gastrostomy in facilitating therapy of head and neck cancer and optimizing the body mass index of the obese patient. JPEN J Parenter Enteral Nutr. 2009;33:404-410.
7.
SilanderENymanJBoveMJohanssonLLarssonSHammerlidE. Impact of prophylactic percutaneous endoscopic gastrostomy on malnutrition and quality of life in patients with head and neck cancer: a randomized study. Head Neck. 2012;34:1-9.
8.
SalasSBaumstarck-BarrauKAlfonsiM. Impact of the prophylactic gastrostomy for unresectable squamous cell head and neck carcinomas treated with radio-chemotherapy on quality of life: prospective randomized trial. Radiother Oncol. 2009;93:503-509.
9.
RutterCEYovinoSTaylorR. Impact of early percutaneous endoscopic gastrostomy tube placement on nutritional status and hospitalization in patients with head and neck cancer receiving definitive chemoradiation therapy. Head Neck. 2011;33:1441-1447.
10.
ScolapioJSSpanglerPRRomanoMMMcLaughlinMPSalassaJR. Prophylactic placement of gastrostomy feeding tubes before radiotherapy in patients with head and neck cancer: is it worthwhile?J Clin Gastroenterol. 2001;33:215-217.
11.
HutchesonKABarringerDARosenthalDIMayAHRobertsDBLewinJS. Swallowing outcomes after radiotherapy for laryngeal carcinoma. Arch Otolaryngol Head Neck Surg. 2008;134:178-183.
12.
RaynorEMWilliamsMFMartindaleRGPorubskyES. Timing of percutaneous endoscopic gastrostomy tube placement in head and neck cancer patients. Otolaryngol Head Neck Surg. 1999;120:479-482.
13.
RingashJLockwoodGO’SullivanB. Hyperfractionated, accelerated radiotherapy for locally advanced head and neck cancer: quality of life in a prospective phase I/II trial. Radiother Oncol. 2008;87:181-187.
14.
MadhounMFBlankenshipMMBlankenshipDMKremplGATierneyWM. Prophylactic PEG placement in head and neck cancer: how many feeding tubes are unused (and unnecessary)?World J Gastroenterol. 2011;17:1004-1008.
15.
RabinovitchRGrantBBerkeyBA. Impact of nutrition support on treatment outcome in patients with locally advanced head and neck squamous cell cancer treated with definitive radiotherapy: a secondary analysis of RTOG trial 90-03. Head Neck. 2006;28:287-296.
16.
van der MolenLHeemsbergenWDde JongR. Dysphagia and trismus after concomitant chemo-intensity-modulated radiation therapy (chemo-IMRT) in advanced head and neck cancer; dose-effect relationships for swallowing and mastication structures. Radiother Oncol. 2013;106:364-369.
17.
Carnaby-MannGCraryMASchmalfussIAmdurR. “Pharyngocise”: randomized controlled trial of preventative exercises to maintain muscle structure and swallowing function during head-and-neck chemoradiotherapy. Int J Radiat Oncol Biol Phys. 2012;83:210-219.
18.
van der MolenLvan RossumMABurkheadLMSmeeleLERaschCRHilgersFJ. A randomized preventive rehabilitation trial in advanced head and neck cancer patients treated with chemoradiotherapy: feasibility, compliance, and short-term effects. Dysphagia. 2011;26:155-170.
19.
RetelVPvan der MolenLHilgersFJ. A cost-effectiveness analysis of a preventive exercise program for patients with advanced head and neck cancer treated with concomitant chemo-radiotherapy. BMC Cancer. 2011;11:475.
20.
JackDRDawsonFRReillyJEShoaibT. Guideline for prophylactic feeding tube insertion in patients undergoing resection of head and neck cancers. J Plast Reconstr Aesthet Surg. 2012;65:610-615.
21.
KoyfmanSAAdelsteinDJ. Enteral feeding tubes in patients undergoing definitive chemoradiation therapy for head-and-neck cancer: a critical review. Int J Radiat Oncol Biol Phys. 2012;84:581-589.
22.
LocherJLBonnerJACarrollWR. Prophylactic percutaneous endoscopic gastrostomy tube placement in treatment of head and neck cancer: a comprehensive review and call for evidence-based medicine. JPEN J Parenter Enteral Nutr. 2011;35:365-374.
23.
LeeJHMachtayMUngerLD. Prophylactic gastrostomy tubes in patients undergoing intensive irradiation for cancer of the head and neck. Arch Otolaryngol Head Neck Surg. 1998;124:871-875.
24.
BeaverMEMathenyKERobertsDBMyersJN. Predictors of weight loss during radiation therapy. Otolaryngol Head Neck Surg. 2001;125:645-648.
25.
PiquetMAOzsahinMLarpinI. Early nutritional intervention in oropharyngeal cancer patients undergoing radiotherapy. Support Care Cancer. 2002;10:502-504.
26.
LangiusJAZandbergenMCEerensteinSE. Effect of nutritional interventions on nutritional status, quality of life and mortality in patients with head and neck cancer receiving (chemo)radiotherapy: a systematic review. Clin Nutr. 2013;32:671-678.
27.
ChangJHGoslingTLarsenJPowellSScanlonRChanderS. Prophylactic gastrostomy tubes for patients receiving radical radiotherapy for head and neck cancers: a retrospective review. J Med Imaging Radiat Oncol. 2009;53:494-499.
28.
ChenAMLiBQLauDH. Evaluating the role of prophylactic gastrostomy tube placement prior to definitive chemoradiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys. 2010;78:1026-1032.
29.
NugentBParkerMJMcIntyreIA. Nasogastric tube feeding and percutaneous endoscopic gastrostomy tube feeding in patients with head and neck cancer. J Hum Nutr Diet. 2010;23:277-284.
30.
Jager-WittenaarHDijkstraPUVissinkA. Changes in nutritional status and dietary intake during and after head and neck cancer treatment. Head Neck. 2011;33:863-870.
31.
IseliTAKulbershBDIseliCECarrollWRRosenthalELMagnusonJS. Functional outcomes after transoral robotic surgery for head and neck cancer. Otolaryngol Head Neck Surg. 2009;141:166-171.
32.
CollanJLundbergMVaalavirtaL. Patterns of relapse following surgery and postoperative intensity modulated radiotherapy for oral and oropharyngeal cancer. Acta Oncol. 2011;50:1119-1125.
33.
ChenAMLiJBeckettLA. Differential response rates to irradiation among patients with human papillomavirus positive and negative oropharyngeal cancer. Laryngoscope. 2013;123:152-157.
34.
HongAMDobbinsTALeeCS. Human papillomavirus predicts outcome in oropharyngeal cancer in patients treated primarily with surgery or radiation therapy. Br J Cancer. 2010;103:1510-1517.
35.
BaschnagelAMYadavSMarinaO. Toxicities and costs of placing prophylactic and reactive percutaneous gastrostomy tubes in patients with locally advanced head and neck cancers treated with chemoradiotherapy [published online July 12, 2031]. Head Neck. doi:10.1002/hed.23426.
