Enteral feeding during chemoradiotherapy for advanced head-and-neck cancer: a single-institution experience using a reactive approach.
OBJECTIVE
The optimal method for providing enteral nutrition to patients with head-and-neck cancer is unclear. The purpose of the present study was to evaluate the safety and efficacy of our reactive policy, which consists of the installation of a nasogastric (NG) feeding tube only when required by the patient's nutritional status.


METHODS
The records of all patients with Stage III and IV head-and-neck cancer treated with concomitant chemotherapy and radiotherapy between January 2003 and December 2006 were reviewed. The overall and disease-free survival rates were estimated using the Kaplan-Meier method and compared with the log-rank test.


RESULTS
The present study included 253 patients, and the median follow-up was 33 months. At 3 years, the estimated overall survival and disease-free survival rate was 82.8% and 77.8%, respectively, for the whole population. No survival difference was observed when the patients were compared according to the presence and absence of a NG tube or stratified by weight loss quartile. The mean weight loss during treatment for all patients was 10.4%. The proportion of patients requiring a NG tube was 49.8%, and the NG tube remained in place for a median duration of 40 days. No major complications were associated with NG tube installation. Only 3% of the patients were still dependent on enteral feeding at 6 months.


CONCLUSIONS
These results suggest that the use of a reactive NG tube with an interdisciplinary team approach is a safe and effective method to manage malnutrition in patients treated with concomitant chemotherapy and radiotherapy for head-and-neck cancer.
Clavel
Sébastien
S
Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada. sebastien.clavel@umontreal.ca
Fortin
Bernard
B
Després
Philippe
P
Donath
David
D
Soulières
Denis
D
Khaouam
Nader
N
Charpentier
Danielle
D
Bélair
Manon
M
Guertin
Louis
L
Nguyen-Tan
Phuc Felix
PF
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000008:administration & dosage; D002277:Carcinoma / Q000150:complications / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy; D002294:Carcinoma, Squamous Cell; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D044342:Malnutrition / Q000628:therapy*; D008875:Middle Aged; D052016:Mucositis; D018307:Neoplasms, Squamous Cell / Q000150:complications / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy; D010348:Patient Care Team; D011855:Radiodermatitis / Q000209:etiology; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D013280:Stomatitis / Q000209:etiology; D015431:Weight Loss
D016190:Carboplatin; D005472:Fluorouracil