title: Use of gastrostomy in head and neck cancer: a systematic review to identify areas for future research.
abstract: OBJECTIVE
  To perform a systematic review of studies, which investigate the role of gastrostomy tube feeding in head and neck squamous cell cancer.
  
  
  METHODS
  A systematic review of the English literature, identifying areas of clinical equipoise and recommendations for future studies.
  
  
  METHODS
  Varying practices in G-tube use in HNSCC, the benefits and disadvantages of G-tubes, the effect of G-tube placement on multidimensional outcomes in patients with head and neck cancer, including quality of life and health economics and to draw themes that may lend themselves to future research.
  
  
  RESULTS
  The search identified 216 articles of which 59 were considered relevant. During treatment, a significant number of patients need enteral nutritional supplementation through nasogastric or G-tubes. Gastrostomy tubes have a good safety profile. Most clinicians agree that the use should be restricted to advanced tumours. Studies on prophylactic insertion of G-tubes do not show a consistent advantage to the nutritional status compared with NG tubes. At 1 year, G-tube retention rates vary between 10% and 30%. The presence of a feeding tube has a negative impact on quality of life. Placing G-tubes may have an adverse effect on swallowing after chemoradiation.
  
  
  CONCLUSIONS
  There is a lack of consensus among clinicians about indications for placing G-tubes. There is sufficient equipoise in this area for further investigation of the effect of varying feeding practices on functional outcomes, quality of life and health economics.
authors.affiliation: The Newcastle upon Tyne Foundation Hospitals NHS Trust, Newcastle Upon Tyne, UK. vinidh.paleri@ncl.ac.uk
authors.forename: V
authors.initials: V
authors.lastname: Paleri
authors.forename: J
authors.initials: J
authors.lastname: Patterson
mesh_terms: D035843:Biomedical Research / Q000639:trends*; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery*; D005774:Gastrostomy / Q000379:methods*; D006258:Head and Neck Neoplasms / Q000150:complications / Q000601:surgery*; D006801:Humans; D016896:Treatment Outcome