The impact of early percutaneous endoscopic gastrostomy placement on treatment completeness and nutritional status in locally advanced head and neck cancer patients receiving chemoradiotherapy

Abstract

To investigate the impact of early insertion of percutaneous endoscopic gastrostomy-tube on nutritional status and completeness of concurrent chemotherapy in locally advanced head and neck cancer patients treated with chemoradiotherapy. Twenty-three patients were enrolled into this prospective study. Gastrostomy-tube was inserted in patients before the initiation of chemoradiotherapy. There was not any significant change in nutritional parameters of patients that used their tube during treatment. Despite the grade 3 mucositis, the planned concurrent chemotherapy could be given in 70% of the patients. However, nine patients had weak compliance and their body weight (P = 0.01) and body mass index (P = 0.01) deteriorated in the first 4 weeks of chemoradiotherapy. The completeness of concurrent chemo-rate was 44% in these patients. Toxicity, requiring aggressive supportive care, may limit the chemotherapy part of curative concomitant chemoradiotherapy. By providing adequate enteral nutrition the insertion of gastrostomy-tube can increase the completeness rate of concurrent chemotherapy.

Disease‐induced and treatment‐induced alterations in body composition in locally advanced head and neck squamous cell carcinoma

“…However, the majority of the population in these studies were overweight or obese at the start of CRT, which has been shown to be linked to higher levels of weight loss during oncological treatment . The current results are, however, comparable with those of Atasoy et al Despite TF administration, weight loss was still substantial and reached a mean of 3.0 ± 3.2 kg after CRT completion. However, this was significantly lower ( P < 0.001) than the weight loss in the TOD group (5.5 ± 3.7 kg).…”

“…Atasoy et al did not find changes in lean body mass and body FM during CRT, and Isenring et al found a trend towards increased FFM in the nutritional intervention group compared with usual care. Differences in nutritional intervention strategies might explain this dissimilarity.…”

Pretreatment weight status and weight loss among head and neck cancer patients receiving definitive concurrent chemoradiation therapy: implications for nutrition integrated treatment pathways

“…Nutrition counseling and support, however, can minimize the amount of weight lost [35, 36]. Recently, a prospective non-randomized study compared the effect of intensive nutritional intervention on weight loss, daily setup variations, and planning target volume margins among head and neck cancer patients undergoing radiation therapy [37].…”

“…New foci for investigation rightly include the establishment of prognostic indicators and development of predictive models for the identification of patients who will benefit most from integrated nutrition therapy. Along with pretreatment weight status, other indicators identified include tumor location and stage, expectation of high grade mucositis, ≥60 Gy total radiation dose, radiotherapy field comprising swallowing structures, pretreatment diet consistency, and multimodal therapy [13, 18, 36, 44, 45]. Wermker et al developed two prediction models with a prognostic accuracy of 90 % [46].…”

Predictive Factors for Preoperative Percutaneous Endoscopic Gastrostomy Placement

“…In patients undergoing radiation and/or chemotherapy, numerous studies have shown the benefits of early PEG placement. 6,[18][19][20] There, however, is no consensus on the optimization of nutrition or the timing of PEG placement. This results in highly variable criteria and guidelines among many centers treating these patients.…”