Percutaneous endoscopic gastrostomy in oropharyngeal cancer patients treated with intensity‐modulated radiotherapy with concurrent chemotherapy

Romesser, Paul B.; Romanyshyn, Jonathan; Schupak, Karen D.; Setton, J.; Riaz, Nadeem; Wolden, Suzanne L.; Gelblum, Daphna Y.; Sherman, Eric J.; Kraus, Dennis H.; Lee, Nancy Y.

doi:10.1002/cncr.27633

Cited by 59 publications

(70 citation statements)

References 22 publications

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“…We also demonstrate little harm in postponing PEG tube placement in this patient population. The median time to PEG tube removal was 3.3 months, which is consistent with a recent large study 5 in a similar patient population who underwent concurrent chemotherapy and intensity-modulated radiation therapy with prophylactic PEG tubes placed. In addition, by 1 and 3 months following CRT, no difference was observed in percentage median weight loss between those who required a PEG tube in our study and those who did not.…”

Section: Discussionsupporting

confidence: 76%

“…The placement of prophylactic PEG tubes has been reported in several recent retrospective series as a safe and effective method for preventing nutritional decline during treatment for head and neck cancer. [1][2][3][4][5] However, the placement of a prophylactic PEG tube carries measurable risks, most notably an infection rate of 5% to 8%, along with diarrhea, constipation, electrolyte abnormalities, gastrointestinal bleeding, a clogged lumen and tube replacement, and metastatic seeding at the gastrostomy site. [4][5][6][7] In addition, some groups have suggested that avoidance of PEG tube placement during therapy may be associated with a lower risk of long-term dysphagia outcomes such as PEG tube dependence or pharyngoesophageal stricture.…”

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confidence: 99%

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Risk Factors for Percutaneous Endoscopic Gastrostomy Tube Placement During Chemoradiotherapy for Oropharyngeal Cancer

Ström

Trotti

Kish

et al. 2013

JAMA Otolaryngol Head Neck Surg

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IMPORTANCEPatients with oropharyngeal squamous cell carcinoma undergoing chemoradiotherapy may require percutaneous endoscopic gastrostomy (PEG) tube placement because of dehydration or significant weight loss.OBJECTIVES To determine the need for the reactive placement of a PEG tube during chemoradiotherapy for oropharyngeal cancer and to identify patient or tumor factors associated with reactively requiring the placement of a PEG tube. MAIN OUTCOMES AND MEASURESLogistic regression analysis was used to identify independent risk factors associated with symptomatic requirement for the reactive placement of a PEG tube. RESULTSIn total, 128 patients did not receive a prophylactic PEG tube within 10 days of initiation of chemoradiotherapy. Fifteen of 128 patients (11.7%) required the reactive placement of a PEG tube during or within 3 months of chemoradiotherapy. The median time to PEG tube removal was 3.3 months, and 14 of 15 patients had their PEG tube removed at the last follow-up analysis. Independent risk factors for PEG tube placement included the following: accelerated irradiation fractionation (odds ratio, 4.3; 95% CI, 1.1-16.5; P = .04), a tumor T classification of 3 or higher (odds ratio, 3.5; 95% CI, 1.0-11.9; P = .04), a cumulative cisplatin dose of 200 mg/m 2 or higher (odds ratio, 6.7; 95% CI, 1.2-36.7; P = .03), and a body mass index (calculated as weight in kilograms divided by height in meters squared) of less than 25 (odds ratio, 5.8; 95% CI, 1.4-23.9; P = .02).CONCLUSIONS AND RELEVANCE Although the overall risk is low, a body mass index of less than 25, accelerated irradiation fractionation, a tumor T classification of 3 or higher, and a cumulative cisplatin dose of 200 mg/m 2 or higher are associated with symptomatic need for the reactive placement of a PEG tube in patients with oropharyngeal cancer.

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Section: Discussionsupporting

confidence: 76%

mentioning

confidence: 99%

Risk Factors for Percutaneous Endoscopic Gastrostomy Tube Placement During Chemoradiotherapy for Oropharyngeal Cancer

Ström

Trotti

Kish

et al. 2013

JAMA Otolaryngol Head Neck Surg

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“…Two of the 20 studies were randomized controlled trials (RCTs) [71,72] (see Table 1), one followed a case-control design [83], and the remaining 17 involved observational cohorts (three prospective [84][85][86], nine retrospective [22,44,67,[87][88][89][90][91][92], three mixed (with some outcomes being retrieved retrospectively and others being collected prospectively) [46,93,94], and two unclear [50,95]). …”

Section: Study Characteristicsmentioning

confidence: 99%

The Effect of Prophylactic Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement on Swallowing and Swallow-Related Outcomes in Patients Undergoing Radiotherapy for Head and Neck Cancer: A Systematic Review

et al. 2015

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Patients undergoing radiotherapy for head and neck cancer (HNC) often experience malnutrition and dehydration during treatment. As a result, some centres place PEG tubes prophylactically (pPEG) to prevent these negative consequences. However, recent research has suggested that pPEG use may negatively affect swallowing physiology, function and/or quality of life, especially in the long term. The purpose of this study was to systematically review the literature on pPEG use in HNC patients undergoing radiotherapy and to determine its impact on swallowing-related outcomes. The following electronic databases were searched for all relevant primary research published through February 24, 2014: AMED, CINAHL, the Cochrane Library, Embase, Healthstar, Medline, and PsycINFO. Main search terms included HNC, radiotherapy, deglutition disorders, feeding tube(s), and prophylactic or elective. References for all accepted papers were hand searched to identify additional relevant research. Methodological quality was assessed using Cochrane's Risk of Bias. At all levels, two blinded raters provided judgments. Discrepancies were resolved by consensus. The search retrieved 181 unique citations. Twenty studies met our inclusion criteria. Quality assessment revealed that all studies were at risk for bias due to non-randomized sampling and unreported or inadequate blinding. Ten studies demonstrated selection bias with significant baseline differences between pPEG patients and controls. Results regarding the frequency and severity of dysphagia and swallowing-related outcomes were varied and inconclusive. The impact of pPEG use on swallowing and swallowing-related outcomes remains unclear. Well-controlled, randomized trials are needed to determine if pPEG places patients at greater risk for developing long-term dysphagia.

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“…Because the aspiration rates ranged from %36 to %81 in the published studies which was higher than our rate (19)(20)(21)(22). The strongest part of our study and Patterson's study about showing the actual aspiration rate may be that patients who reported normal swallowing were not excluded from the study (18). While the aspiration severity was gradually increased by the time, there is also a gradual decrease in weight of the patients.…”

Section: Discussionmentioning

confidence: 38%

Swallowing and quality of life outcomes early after radiation therapy in head and neck cancer patients

Arslan

Demir

Cengiz

et al. 2015

Turk J Physiother Rehabil

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which are specific to cancer patients with acceptable validity and reliability were used for quality of life assessment. All evaluations were performed three times including before radiotherapy, 1 and 3 months after radiotherapy. Results: The aspiration severity were gradually increased after radiotherapy (p<0.001). There was no difference after radiotherapy in all subscales of EORTC QLQ-C30 (p>0.0166). Pain and feeling illness decreased (p<0.001), swallowing problems, dry mouth, sticky saliva (p<0.001), teeth, mouth-opening problems (p<0.016) increased after radiotherapy. There was a moderate, negative correlation between aspiration severity and general health status scale (p<0.001). There was a moderate, positive correlation between aspiration severity and symptom scale, swallowing ability, social eating, dry mouth, sticky saliva and coughing (p<0.05). Discussion: It can be concluded that swallowing function and swallowing related quality of life parameters were affected negatively in the early period after radiotherapy despite no change in general quality of life perception. It is important for clinicians to be aware of swallowing disorders and its effects on quality of life in the early period to prevent patients from potential long-term effects of swallowing disorders on general quality of life. Amaç: Çalışmanın amacı; baş boyun kanserli (BBK) hastalarda radyoterapi sonrası erken dönemde yutma fonksiyonu ve yaşam kalitesindeki değişiklikleri belirlemektir. Yöntemler: Çalışmaya BBK'lı 40 hasta dahil edildi. Yutma fonksiyonu Modifiye Baryum Yutma Çalışması ile değerlendirildi. Penetrasyon aspirasyon şiddetine karar vermek için Penetrasyon As-pirasyon Skalası kullanıldı. Yaşam kalitesi değerlendirmesi için kanser hastalarına özel, geçerliliği ve güvenirliği olan European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) ve European Organization for the Research and Treatment of Cancer, Quality of Life assessments in Head and Neck Cancer (EORTC QLQ-H&N35) ölçekleri kullanıldı. Tüm değerlendirmeler radyoterapi öncesi, radyoterapi sonrası bir ve üç ayda olmak üzere üç defa yapıldı. Sonuçlar: Radyoterapi sonrası aspirasyon şiddeti giderek arttı (p<0.001). EORTC QLQ-C30'un tüm alt basamaklarında radyoterapi sonrası fark olmadığı bulundu (p>0.0166). Ağrı ve kendini hasta hissetme azaldı (p<0.001), yutma problemleri, ağız kuruluğu, tükrük yapışkanlığı (p<0.001), diş ve ağız açma problemleri (p<0.016) radyoterapi sonrası arttı. Aspirasyon şiddeti ile genel sağlık duru-mu arasında orta düzeyde, negatif yönde (p<0.001) ilişki vardı. Aspirasyon şiddeti ile semptom ska-lası, yutma yeteneği, sosyal yeme davranışı, ağız kuruluğu, tükrük yapışkanlığı ve öksürme arasında orta düzeyde, pozitif yönde ilişki bulundu (p<0.05). Tartışma: Radyoterapi sonrası erken dönemde genel yaşam kalitesi algısında değişiklik olmama-sına rağmen yutma fonksiyonu ve yutma ile ilişkili yaşam kalitesi parametreleri olumsuz etkilendiği sonucuna varıldı. Klinisyenlerin, hastalarını yutma bozukluğunun ...

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Percutaneous endoscopic gastrostomy in oropharyngeal cancer patients treated with intensity‐modulated radiotherapy with concurrent chemotherapy

Cited by 59 publications

References 22 publications

Risk Factors for Percutaneous Endoscopic Gastrostomy Tube Placement During Chemoradiotherapy for Oropharyngeal Cancer

Risk Factors for Percutaneous Endoscopic Gastrostomy Tube Placement During Chemoradiotherapy for Oropharyngeal Cancer

The Effect of Prophylactic Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement on Swallowing and Swallow-Related Outcomes in Patients Undergoing Radiotherapy for Head and Neck Cancer: A Systematic Review

Swallowing and quality of life outcomes early after radiation therapy in head and neck cancer patients

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