Gastrostomy tubes in patients with advanced head and neck cancer.
OBJECTIVE
To measure the percentage of patients requiring gastrostomy tubes (G-tubes) and the timing of their placement, in addition to studying whether pretreatment variables (T stage, tumor site, N stage) and intratreatment variables (weight loss during treatment) are valid predictors for the need for G-tube placement.


METHODS
Retrospective case control study.


METHODS
Retrospective review of a prospectively collected database with chart reviews was carried out on 477 patients treated on a regimen of intraarterial cisplatin and concurrent radiation. The likelihood of requiring a G-tube was calculated by studying several independent variables using chi-square analysis and the unpaired t test.


RESULTS
Two hundred twenty (46%) patients had G-tubes placed, with mean time of placement being on day 20 after the initiation of treatment. Patients with T4 disease were statistically more likely to require a G-tube (50% vs. 37%, P < .05). Patients were less likely to require a G-tube when the primary site of tumor involved the larynx or paranasal sinuses (P < .05). There were no statistically significant differences between the two groups with regards to patient age, sex, N stage, and weight changes over the course of treatment. The odds of requiring a G-tube were highest for tumors involving the hypopharynx (80%), oral cavity (52%), and oropharynx (49%).


CONCLUSIONS
Although clinical judgment appears to be sufficient for deciding when G-tube placement is warranted in our population, the threshold for placing a tube should be lower in those patients who had a higher likelihood of requiring a G-tube during the course of treatment, including those with advanced disease of the oral cavity, oropharynx, and hypopharynx.
Ahmed
Khwaja Asif
KA
Department of Otolaryngology-Head and Neck Surgery, University of Tennessee Health Sciences Center, Memphis, TN 38103, USA.
Samant
Sandeep
S
Vieira
Francisco
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D004750:Enteral Nutrition; D005260:Female; D005774:Gastrostomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010039:Otorhinolaryngologic Neoplasms / Q000473:pathology / Q000628:therapy*