title: Prophylactic percutaneous endoscopic gastrostomy in patients with advanced head and neck tumors treated by combined chemoradiotherapy.
abstract: BACKGROUND
  Few studies have evaluated outcomes of combined chemoradiotherapy for Stage III-IV head and neck squamous cell carcinoma in terms of the use of nutritional support by means of percutaneous endoscopic gastrostomy (PEG).
  
  
  OBJECTIVE
  To compare nutritional status and treatment interruption because of acute toxicity in patients with advanced head and neck tumors who were treated by combined chemoradiotherapy and received or did not receive prophylactic PEG tubes.
  
  
  METHODS
  This was a retrospective study that evaluated data obtained from a cancer center in Montpellier, France. A total of 139 consecutive patients treated for Stage III-IV head and neck squamous cell carcinoma from January 1, 1998 to June 30, 2003 were evaluated in terms of nutritional status before and after therapy, treatment interruption because of toxicity, and duration of hospitalization.
  
  
  RESULTS
  Seventy-eight of the 139 patients (58%) did not receive prophylactic PEG feeding, and 61 patients (44%) received PEG feeding. Pretreatment nutritional status was worse in the PEG group. Compared with the initial nutritional status, nutritional status at the end of treatment was unchanged in the PEG group and much worse in the group that did not receive the PEG (P<0.05). Cumulative incidence of treatment interruption because of toxicity was significantly lower in the PEG group than in the no-PEG group (100 and 236 days of interruption, respectively, P=0.03) and hospitalization was significantly shorter (P=0.003).
  
  
  CONCLUSIONS
  Prophylactic PEG sustains nutritional status and reduces the cumulative incidence of treatment interruption caused by toxicity and duration of hospitalization. A randomized study is warranted to validate these results.
authors.affiliation: Department of Gastro-Nutrition, Val d'Aurelle Cancer Institute, Montpellier, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Assenat
authors.forename: Simon
authors.initials: S
authors.lastname: Thezenas
authors.forename: Nicolas
authors.initials: N
authors.lastname: Flori
authors.forename: Nicole
authors.initials: N
authors.lastname: Pere-Charlier
authors.forename: Renaud
authors.initials: R
authors.lastname: Garrel
authors.forename: Antoine
authors.initials: A
authors.lastname: Serre
authors.forename: David
authors.initials: D
authors.lastname: Azria
authors.forename: Pierre
authors.initials: P
authors.lastname: Senesse
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods*; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D012189:Retrospective Studies; D016896:Treatment Outcome