title: Radiation technique influence on percutaneous endoscopic gastrostomy tube dependence: Comparison between two radiation schemes.
abstract: BACKGROUND
  Our aim was to determine whether percutaneous endoscopic gastrostomy (PEG) dependence was significantly different between 2 prospective trials with different radiation fractionation schemes.
  
  
  METHODS
  Stage III or IV locally advanced head and neck squamous cell carcinomas arising from the oral cavity, hypopharynx, oropharynx, nasopharynx, paranasal sinuses, or larynx were treated using hyperfractionation (A-3 protocol) or accelerated fractionation (A-4 protocol) with chemotherapy. Amifostine was administered 15 to 30 minutes preradiation, at a dose of 500 mg/day in both protocols. It was given as an infusion over 5 to 7 minutes (A-3 protocol) or subcutaneously (A-4 protocol). Data regarding PEG placement and removal were collected prospectively.
  
  
  RESULTS
  Thirty-five evaluable A-3 protocol patients, 14 evaluable A-4 protocol patients, and 6 patients treated per A-4 protocol guidelines, but without amifostine as they refused the medication, were included in the analysis. Pretreatment characteristics, such as sex, age, race, T classification, N classification, American Joint Committee on Cancer (AJCC) stage, were compared between the 2 groups of patients. The only significant difference between the 2 groups was AJCC stage. Thirty-five A-3 patients and 20 A-4 patients had overall survivals of 88% versus 80%, 82% versus 75%, and 66% versus 67.5% at 1, 2, and 3 years, respectively (p = .958). With regard to PEG dependence, no significant differences were seen between the 2 groups at 6, 12, or 18 months.
  
  
  CONCLUSIONS
  PEG dependence was not significantly different between the 2 study groups. Type of altered fractionation scheme may not influence PEG dependence in patients treated with similar protocols. Future randomized studies are needed to confirm these findings.
authors.affiliation: Department of Radiation Oncology, University of Miami School of Medicine, Miami, Florida, USA. ghatoum1@med.miami.edu
authors.forename: Georges F
authors.initials: GF
authors.lastname: Hatoum
authors.forename: Andre
authors.initials: A
authors.lastname: Abitbol
authors.forename: Inas
authors.initials: I
authors.lastname: Elattar
authors.forename: Alan
authors.initials: A
authors.lastname: Lewin
authors.forename: Michael
authors.initials: M
authors.lastname: Troner
authors.forename: Frank
authors.initials: F
authors.lastname: Kronberg
authors.forename: Luis E
authors.initials: LE
authors.lastname: Raez
authors.forename: Donald
authors.initials: D
authors.lastname: Weed
authors.forename: May
authors.initials: M
authors.lastname: Abdel-Wahab
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D004724:Endoscopy; D004750:Enteral Nutrition; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents