title: Predictive Factors for Prophylactic Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement and Use in Head and Neck Patients Following Intensity-Modulated Radiation Therapy (IMRT) Treatment: Concordance, Discrepancies, and the Role of Gabapentin.
abstract: The prophylactic placement of a percutaneous endoscopic gastrostomy (PEG) tube in the head and neck cancer (HNC) patient is controversial. We sought to identify factors associated with prophylactic PEG placement and actual PEG use. Since 2010, data regarding PEG placement and use were prospectively recorded in a departmental database from January 2010 to December 2012. HNC patients treated with intensity-modulated radiation therapy (IMRT) were retrospectively evaluated from 2010 to 2012. Variables potentially associated with patient post-radiation dysphagia from previous literature, and our experience was evaluated. We performed multivariate logistic regression on these variables with PEG placement and PEG use, respectively, to compare the difference of association between the two arms. We identified 192 HNC patients treated with IMRT. Prophylactic PEG placement occurred in 121 (63.0 %) patients, with PEG use in 97 (80.2 %) patients. PEG placement was associated with male gender (p < .01), N stage ≥ N2 (p < .05), pretreatment swallowing difficulties (p < .01), concurrent chemotherapy (p < .01), pretreatment KPS ≥80 (p = .01), and previous surgery (p = .02). Concurrent chemotherapy (p = .03) was positively associated with the use of PEG feeding by the patient, whereas pretreatment KPS ≥80 (p = .03) and prophylactic gabapentin use (p < .01) were negatively associated with PEG use. The analysis suggests there were discrepancies between prophylactic PEG tube placement and actual use. Favorable pretreatment KPS, no pretreatment dysphagia, no concurrent chemotherapy, and the use of gabapentin were significantly associated with reduced PEG use. This analysis may help refine the indications for prophylactic PEG placement.
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 North Broadway, Suite 1440, Baltimore, MD, 21231, USA.
authors.forename: Wuyang
authors.identifier: http://orcid.org/0000-0001-5934-7795
authors.initials: W
authors.lastname: Yang
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 North Broadway, Suite 1440, Baltimore, MD, 21231, USA.
authors.forename: Todd R
authors.initials: TR
authors.lastname: McNutt
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 North Broadway, Suite 1440, Baltimore, MD, 21231, USA.
authors.forename: Sara A
authors.initials: SA
authors.lastname: Dudley
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 North Broadway, Suite 1440, Baltimore, MD, 21231, USA.
authors.forename: Rachit
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Starmer
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Christine G
authors.initials: CG
authors.lastname: Gourin
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 North Broadway, Suite 1440, Baltimore, MD, 21231, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Moore
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 North Broadway, Suite 1440, Baltimore, MD, 21231, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Evans
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 North Broadway, Suite 1440, Baltimore, MD, 21231, USA.
authors.forename: Mysha
authors.initials: M
authors.lastname: Allen
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Nishant
authors.initials: N
authors.lastname: Agrawal
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Richmon
authors.affiliation: Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Christine H
authors.initials: CH
authors.lastname: Chung
authors.affiliation: Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 North Broadway, Suite 1440, Baltimore, MD, 21231, USA. hquon2@jhmi.edu.|Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. hquon2@jhmi.edu.|Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. hquon2@jhmi.edu.
authors.forename: Harry
authors.initials: H
authors.lastname: Quon
mesh_terms: D000368:Aged; D000588:Amines / Q000627:therapeutic use; D000700:Analgesics / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use; D003680:Deglutition Disorders / Q000209:etiology / Q000517:prevention & control*; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D000077206:Gabapentin; D005773:Gastroscopy / Q000379:methods; D005774:Gastrostomy / Q000379:methods; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D065286:Prophylactic Surgical Procedures / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012189:Retrospective Studies; D012737:Sex Factors; D005680:gamma-Aminobutyric Acid / Q000627:therapeutic use
chemical_list: D000588:Amines; D000700:Analgesics; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin
keywords: Deglutition; Head and neck cancer; Intensity-modulated radiation therapy; Percutaneous endoscopic gastrostomy; Predictive factor; Radiation therapy