title: Management of patients treated with chemoradiotherapy for head and neck cancer without prophylactic feeding tubes: the University of Pittsburgh experience.
abstract: OBJECTIVE
  Mucositis and dysphagia are common complications of chemoradiotherapy (CRT) for head and neck cancer that may necessitate nutritional support with a gastrostomy tube (G-tube).
  
  
  METHODS
  We reviewed records of patients who underwent and completed CRT, which included at least one traditional chemotherapeutic, for previously untreated head and neck cancer. G-tubes were placed as needed. The timing and duration of G-tube placement and treatment-related complications and risk factors for long-term G-tube use were analyzed.
  
  
  RESULTS
  A total of 91 consecutive patients who received CRT, 68 as primary and 23 as postoperative treatment, were studied. Radiation doses ranged from 59.4 to 74 Gy (median, 70 Gy). Seventy-nine percent of patients received platinum-based therapy during CRT. Severe mucositis occurred in 40% of patients. Forty percent of patients required G-tube placement (15 prior to CRT and 21 during CRT). Median duration of G-tube use was 5.8 months. Two patients who had a G-tube placed during CRT developed a G-tube-related complication. At 6 and 12 months, 15 (18%) and four (6%) patients who were disease free were using G-tubes, respectively. Patients with G-tubes placed prior to CRT or advanced T stage had longer G-tube dependence.
  
  
  CONCLUSIONS
  With aggressive supportive care it is feasible to avoid G-tubes in the majority of patients undergoing CRT for head and neck cancer. G-tube placement prior to CRT due to pre-existing dysphagia and advanced T stage are associated with prolonged G-tube dependence.
authors.affiliation: Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15232, USA.
authors.forename: Brian T
authors.initials: BT
authors.lastname: McLaughlin
authors.forename: Abhay S
authors.initials: AS
authors.lastname: Gokhale
authors.forename: Yongli
authors.initials: Y
authors.lastname: Shuai
authors.forename: Joyce
authors.initials: J
authors.lastname: Diacopoulos
authors.forename: Ricardo
authors.initials: R
authors.lastname: Carrau
authors.forename: Dwight E
authors.initials: DE
authors.lastname: Heron
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Smith
authors.forename: Michael K
authors.initials: MK
authors.lastname: Gibson
authors.forename: Robert L
authors.initials: RL
authors.lastname: Ferris
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Grandis
authors.forename: Jonas T
authors.initials: JT
authors.lastname: Johnson
authors.forename: Athanassios
authors.initials: A
authors.lastname: Argiris
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy / Q000009:adverse effects; D003680:Deglutition Disorders / Q000209:etiology; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D052016:Mucositis / Q000209:etiology; D011879:Radiotherapy Dosage