Prophylactic percutaneous endoscopic gastrostomy in patients with head and neck cancer undergoing radiotherapy and chemotherapy

doi:10.19438/j.cjoms.2018.02.014

Abstract

Abstract: PURPOSE: To investigate the timing of percutaneous endoscopic gastrostomy (PEG) in patients with head and neck cancer undergoing radiotherapy and chemotherapy. METHODS: This retrospective study analyzed the data of patents with head and neck cancer who underwent radio-chemotherapy from January 2016 to December 2016 (patients required gastrostomy according to nutritional risk assessed by radiotherapy physicians). With informed consent the patients were divided into chemotherapy before gastrostomy (prophylactic PEG group) and chemotherapy during gastrostomy (reactive PEG group). There were 234 cases in prophylactic PEG group and 93 cases in reaction PEG group. BMI and albumin level of patients were recorded and analyzed before and after cathetering. Wound infections and extubation rates of the two groups were also recorded and compared. SPSS 11.5 software package was used for comparison between the two groups. RESULTS: After chemotherapy and radiotherapy, BMI, albumin and extubation rates of the prophylactic PEG group were significantly higher than those of the reactive PEG group (P<0.01), while the infection rate in the prophylactic PEG group was significantly lower than that in the reactive PEG group (P<0.05). CONCLUSIONS: Prophylactic PEG can improve the nutritional status of patients with head and neck cancer after radiotherapy and chemotherapy, and reduce complications of radiotherapy and chemotherapy.

Key words: Percutaneous endoscopic gastrostomy, Head and neck cancer, Prophylactic PEG, Reactive PEG

CLC Number:

R739.8

QIAN Li, GE Kui, XU Bing, WU Jia-jun, WANG Fan-lin, FAN Jing-xian, ZHANG Lin. Prophylactic percutaneous endoscopic gastrostomy in patients with head and neck cancer undergoing radiotherapy and chemotherapy[J]. China Journal of Oral and Maxillofacial Surgery, 2018, 16(2): 167-170.

References

[1] Cady J.Nutritional support during radiotherapy for head and neck cancer: the role of prophylactic feeding tube placement[J]. Clin J Oncol Nurs, 2007, 11(6): 875-880.
[2] Brizel DM, Albers ME, Fisher SR, et al.Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer[J]. New Engl J Med, 1998, 338(25): 1798-1804.
[3] Lee H, Havrila C, Bravo V, et al.Effect of oral nutritional supplementation on weight loss and percutaneous endoscopic gastrostomy tube rates in patients treated with radiotherapy for oropharyngeal carcinoma[J]. Support Care Cancer, 2008, 16(3): 285-289.
[4] Machtay M, Rosenthal DI, Hershock D, et al.Organ preservation therapy using induction plus concurrent chemoradiation for advanced respectable oropharyngeal carcinoma: a University of Pennsylvania phase II trial[J]. J Clin Oncol, 2002, 20(19): 3964-3971.
[5] Kubrak C, Olson K, Jha N, et al.Nutrition impact symptoms: key determinants of reduced dietary intake, weight loss, and reduced functional capacity of patients with head and neck cancer before treatment[J]. Head Neck, 2010, 32(3): 290-300.
[6] Sobotka L 著, 蔡威译. 临床营养基础 [M]. 第3版. 上海: 复旦大学出版社, 2007: 418.
[7] 张志愿, 郑家伟, 王中和. 晚期头颈鳞癌: 术前放疗还是术后放疗?[J]. 中国口腔颌面外科杂志, 2009, 7(1): 2-3.
[8] James SS, Phillip RS, Michelle MR, et al.Prophylactic placement of gastrostomy feeding tubes before radiotherapy in patients with head and neck cancer: is it worthwhile[J]. J Clin Gastroenterol, 2001, 33(3): 215-217.
[9] Madhoun MF, Blankenship MM, Blankenship DM, et al.Prophylactic PEG placement in head and neck cancer: how many feeding tubes are unused (and unnecessary)?[J]. World J Gastroenterol, 2011, 17(8): 1004-1008.
[10] Chasen MR, Bhargava R.A descriptive review of the factors contributing to nutritional compromise in patients with head and neck cancer[J]. Support Care Cancer, 2009, 17(11): 1345-1351.
[11] Sanguineti G, Sormani MP, Marur S, et al.Effect of radiotherapy and chemotherapy on the risk of mucositis during intensity-modulated radiation therapy for oropharyngeal cancer[J]. Int J Radiat Oncol Biol Phys, 2012, 83(1): 235-242.
[12] Le QT, Kim HE, Schneider CJ, et al.Palifermin reduces severe mucositis in definitive chemoradiotherapy of locally advanced head and neck cancer: a randomized, placebo-controlled study[J]. J Clin Oncol, 2001, 29(20): 2808-2814.
[13] Bossi P, Locati LD, Lictra L.Palifermin in prevention of head and neck cancer radiation-induced mucositis: not yet a definitive word on safety and efficacy profile[J]. J Clin Oncol, 2012, 30(5): 564-565.
[14] Gussgard AM, Hope AJ, Jokstad A, et al.Assessment of cancer therapy-induced oral mucositis using a patient reported oral mucositis experience questionnaire[J]. PLos One, 2014, 9(3): e91733.
[15] Habib SF, Ahmed S, Skelly R, et al.Developing a protocol for gastrostomy tube insertion in patients diagnosed with head and neck cancer[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2013, 117(5): 551-559.
[16] 葛奎, 徐兵, 张霖, 等. 经皮内镜胃造瘘营养支持在头颈部肿瘤放疗中的应用[J]. 中国口腔颌面外科杂志, 2013, 11(4): 308-311.
[17] Anonymous. American Gastroenterological Association medical position statement: guidelines for the use of enteral nutrition[J]. Gastroenterology, 1995, 108(4): 1280-1281.
[18] Wygoda A, Rutkowski T, Hutnik M, et al.Acute mucosal reactions in patients with head and neck cancer. Three patterns of mucositis observed during radiotherapy[J]. Strahlenther Onkol, 2013, 189(7): 547-551.