Enteral Feeding During Chemoradiotherapy for Advanced Head-and-Neck Cancer: A Single-Institution Experience Using a Reactive Approach

Long-term Swallow Function after Chemoradiotherapy for Oropharyngeal Cancer: The Influence of a Prophylactic Gastrostomy or Reactive Nasogastric Tube

“…A large majority of patients require oral or enteral nutritional supplementation during and after treatment. The proportion of patients reported as requiring enteral feeding varies between reported series, with between 50-100% of patients receiving chemoradiotherapy needing enteral nutritional support [3][4][5] . Risk factors for requiring enteral feeding include pre-treatment weight loss and dysphagia, older age, large primary tumours, and treatment related factors including the use of concurrent chemotherapy and radiation dose to the pharyngeal constrictors 6,7 .…”

Influence of dosimetric and clinical criteria on the requirement of artificial nutrition during radiotherapy of head and neck cancer patients

“…In an investigation of Mangar et al [17] ECOG 2 and 3 was more often associated with gastrostomy than ECOG 0 and 1. Concurrent systemic treatment, especially chemotherapy, was almost uniformly identified as predictor for swallowing problems in several other studies [3,21,25,[33][34][35]55]. Besides direct radio-sensitization chemotherapy direct mucosal toxicity, a higher grade of immunosuppression, and drug induced nausea and vomiting may facilitate the development of mucositis and consequently dysphagia.…”

Optimising nutrition support in patients with head and neck cancer

“…A gastrostomy tube is preferred if anticipated duration of nutrition support is likely to be greater than four weeks (Arends et al, 2006). Historically, many centres favoured the proPEG method, however there has been a trend in recent times to move away from this approach and favour reactive management with an NGT (Clavel et al, 2011;Lawson et al, 2009;Madhoun, Blankenship, Blankenship, Krempl, & Tierney, 2011).…”

“…A separate study utilising a reactive feeding approach with nasogastric tubes also reported a mean weight loss of 10.4% during treatment, with a weight loss of >10% affecting over half of their patients (54%) (Clavel et al, 2011).…”

“…A recent meta-analyses comparing outcomes with nasogastric tubes and either prophylactic or reactive gastrostomy tubes, found the prophylactic tubes resulted in a reduction in treatment interruptions and nutrition related hospital admissions, but had no superiority in managing nutritional status (Zhang et al, 2016). Either way, clinically significant weight loss of greater than 10% occurs with either the prophylactic or reactive approach (Silander et al, 2012, Chang et al, 2009, Rutter et al, 2011, Clavel et al, 2011, Olson et al, 2013.…”