Radiation technique influence on percutaneous endoscopic gastrostomy tube dependence: Comparison between two radiation schemes.
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.
Hatoum
Georges F
GF
Department of Radiation Oncology, University of Miami School of Medicine, Miami, Florida, USA. ghatoum1@med.miami.edu
Abitbol
Andre
A
Elattar
Inas
I
Lewin
Alan
A
Troner
Michael
M
Kronberg
Frank
F
Raez
Luis E
LE
Weed
Donald
D
Abdel-Wahab
May
M
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
D000970:Antineoplastic Agents