Enteral Feeding Tubes in Patients Undergoing Definitive Chemoradiation Therapy for Head-and-Neck Cancer: A Critical Review

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

“…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 .…”

“…A gastrostomy tube is usually preferred for the former approach and a nasogastric (NG) tube for the latter 6 . A recent UK based survey revealed no consensus as to which patients should be offered a prophylactic gastrostomy 8 .…”

“…Several studies have suggested that the use of prophylactic gastrostomy placement is associated with a reduction in weight loss during treatment, a lower rate of hospitalisation 4,[9][10][11] , and improved quality of life during and soon after treatment 12,13 . Disadvantages of prophylactic gastrostomy placement prior to treatment include the possibility that the tube will not be required, a small risk of tube-related morbidity 14 , and the uncertain influence upon long term enteral feeding dependency rates 6,[9][10][11]15 .…”

“…Long term swallow function is an major factor influencing long term quality of life in survivors 6 .…”

“…Several studies have reported a significantly increased duration of enteral feeding with prophylactic gastrostomies compared with a reactive enteral feeding approach 9,10,15,18 . This has led to concern that the use of prophylactic gastrostomy tubes may lead to poorer long term swallow function 6,11,19 . However, there is very little data examining long term swallow function in relation to the route of enteral nutritional support during treatment.…”