title: A prospective study comparing prophylactic gastrostomy to nutritional counselling with a therapeutic feeding tube if required in head and neck cancer patients undergoing chemoradiotherapy in Thai real-world practice.
abstract: Concurrent chemoradiotherapy (CRT) is the standard treatment for head and neck (HN) cancer patients. Most patients experience malnutrition and weight loss during treatment because of mucositis and difficulty in swallowing. Prevention of malnutrition may allow more patients to complete their treatment. The present study aimed to examine whether prophylactic gastrostomy tube (PGT) could reduce treatment interruption, prevent malnutrition and maintain quality of life, especially in Thai patients who generally do not accept feeding tubes.
  
  
  
  A prospective study was performed on HN cancer patients undergoing CRT at a tertiary hospital in Thailand (n = 95). Before starting CRT, all patients received nutritional assessment and were counselled about the risks and benefits of PGT. According to patient discretion, they chose to have a PGT (experimental group) or only nutritional counselling with a therapeutic feeding tube if required (control group). During CRT, weight, degree of mucositis, delayed chemotherapy and/or radiotherapy, and nutritional status were recorded. Quality of life (Functional Assessment of Cancer Therapy - Head and Neck Scale; FACT-H&N) was compared between two groups.
  
  
  
  There was no significant difference in the rates of delayed treatment. Mean weight loss was 3.1 and 4.8 kg in the experimental and control groups, respectively (P = 0.04). A higher proportion of patients in the control group experienced ≥10% weight loss (24% versus 4%; P = 0.03). In terms of quality of life, no significant difference in FACT-H&N score was found.
  
  
  
  The results of the present study suggest that PGT provided similar quality of life without a reduction in treatment interruption. However, patients with PGT had significantly less weight loss (P = 0.04) during CRT.
authors.affiliation: Division of Nutrition, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: P
authors.initials: P
authors.lastname: Pramyothin
authors.affiliation: Division of Medical Oncology, Department of Internal Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: S
authors.initials: S
authors.lastname: Manyanont
authors.affiliation: Division of General Surgery, Department of Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: A
authors.initials: A
authors.lastname: Trakarnsanga
authors.affiliation: Division of Radiation Oncology, Department of Radiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: J
authors.initials: J
authors.lastname: Petsuksiri
authors.affiliation: Division of Medical Oncology, Department of Internal Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: S
authors.initials: S
authors.lastname: Ithimakin
mesh_terms: D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy / Q000009:adverse effects*; D003376:Counseling / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000517:prevention & control*; D008875:Middle Aged; D044623:Nutrition Therapy / Q000379:methods*; D065286:Prophylactic Surgical Procedures / Q000379:methods*; D011446:Prospective Studies; D013785:Thailand; D015431:Weight Loss
keywords: chemoradiotherapy; head and neck cancer; prophylactic gastrostomy; treatment interruption