Safety and effectiveness of prophylactic gastrostomy tubes for head and neck cancer patients undergoing chemoradiation.
BACKGROUND
We would like to assess the safety and effectiveness of prophylactic percutaneous endoscopic gastrostomy (PEG) tube feedings during concurrent chemoradiation for head and neck cancer.


METHODS
Patients who underwent chemotherapy and radiation for head and neck malignancies were evaluated for their ability to resume oral feeding following treatment. All patients underwent PEG tube placement prior to the treatment because of the expected mucositis. Gastrostomy tubes were removed following treatment when the patients were able to resume oral feedings without aspiration.


RESULTS
Between March 1999 and 2006, 104 patients with locally advanced head and neck cancer underwent concurrent chemotherapy and radiation. One patient declined placement of gastrostomy tube. Ninety patients (86%) developed grade 3-4 mucositis during chemoradiation. Five patients died during treatment from aspiration pneumonia and sepsis. One hundred two patients lost weight during treatment. The mean and median weight loss during concurrent therapy was, respectively, 8.5 and 8 kg (1-23.5 kg). Following treatment, tube feedings were continued 1-41 months (mean: 8 months; median: 5 months) because of continued weight loss, chronic dysphagia, or aspiration. At a median follow-up of 19 months (1-62 months), no patient developed serious complications from tube feedings.


CONCLUSIONS
Dysphagia resulting from the severe mucositis produced severe weight loss, despite tube feedings. Gastrostomy tube feedings are safe. Gastrostomy tubes should be placed prophylactically for patients undergoing chemoradiation for head and neck cancer.
Nguyen
Nam P
NP
Department of Radiation Oncology, University of Arizona, 101 N Campbell Avenue, P.O Box 45081 Tucson, AZ 85724-508, USA. NamPhong.Nguyen@yahoo.com
North
Debra
D
Smith
Herbert J
HJ
Dutta
Suresh
S
Alfieri
Alan
A
Karlsson
Ulf
U
Lee
Howard
H
Martinez
Tomas
T
Lemanski
Claire
C
Nguyen
Ly M
LM
Ludin
Adir
A
Sallah
Sabah
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D003680:Deglutition Disorders / Q000209:etiology; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects*; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000150:complications; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D015431:Weight Loss