title: 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.
abstract: BACKGROUND
  Chemoradiation of head and neck cancer induces severe dysphagia and malnutrition, which may lead to interruptions in therapy and reduction in its efficacy. Percutaneous endoscopic gastrostomy (PEG) feedings bypass the oropharynx, allowing administration of nutrients and medications into the stomach, thus preventing malnutrition, dehydration, and treatment interruption.
  
  
  METHODS
  Medical records of 161 patients treated for head and neck cancer who had PEGs placed prior to chemoradiation and 2 PEGs placed during chemoradiation were reviewed from the date of PEG placement throughout treatment and utilization. The objective was to determine the contribution of pretreatment PEGs to the therapy of patients with head and neck cancer and to optimize their body mass index.
  
  
  RESULTS
  Severe chemoradiation-induced dysphagia developed in 160 patients (98%), necessitating PEG utilization for feeding and hydration. PEGs were used for a mean 251 +/- 317 days. Significant complications related to PEG placement and utilization were infrequent. PEG feeding allowed chemoradiation to continue without interruption in 93% of patients. Individualized feeding regimens optimized body mass index in obese and overweight patients with a decline from 33.0 +/- 3.4 to 28.4 +/- 4.8 kg/m(2) (P < .001) and 27.3 +/- 1.5 to 24.6 +/- 2.7 kg/m(2) (P < .001), respectively. Radiation-induced strictures developed in 12% of patients, requiring endoscopic dilatation.
  
  
  CONCLUSIONS
  Enteral feeding through prechemoradiation-placed PEGs is an effective and safe method for nutrition and hydration of patients with head and neck cancer undergoing chemoradiation. PEGs allowed chemoradiation to proceed with minimal interruptions despite severe dysphagia, which excluded oral intake for prolonged periods.
authors.affiliation: Department of Medicine, Columbia University College of Physician & Surgeons, New York, New York, USA.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Raykher
authors.forename: Lilia
authors.initials: L
authors.lastname: Correa
authors.forename: Lianne
authors.initials: L
authors.lastname: Russo
authors.forename: Pat
authors.initials: P
authors.lastname: Brown
authors.forename: Nancy
authors.initials: N
authors.lastname: Lee
authors.forename: David
authors.initials: D
authors.lastname: Pfister
authors.forename: Hans
authors.initials: H
authors.lastname: Gerdes
authors.forename: Jatin
authors.initials: J
authors.lastname: Shah
authors.forename: Dennis
authors.initials: D
authors.lastname: Kraus
authors.forename: Mark
authors.initials: M
authors.lastname: Schattner
authors.forename: Moshe
authors.initials: M
authors.lastname: Shike
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003131:Combined Modality Therapy; D003680:Deglutition Disorders / Q000209:etiology; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005773:Gastroscopy; D005774:Gastrostomy / Q000379:methods*; D006258:Head and Neck Neoplasms / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000517:prevention & control; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000503:physiopathology; D012189:Retrospective Studies; D055815:Young Adult