The use of radiologically placed gastrostomy tubes in head and neck cancer patients receiving radiotherapy

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

“…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.…”

Malnutrition and methods of its correction in patients with malignant tumors of the esophagus and stomach

“…Пациентам, проходящим курс лучевой терапии или химиолучевого лечения, также требуется дополнительное энтеральное питание для предотвращения потери массы тела и прерывания курса лечения [10,11]. При наличии стойкой дисфагии у больных данной группы на первом этапе осуществляют эндоскопическое стентирование, про-ведение зонда либо гастростомию, поскольку на началь-ном этапе облучения дисфагия может нарастать вследствие отека.…”

Optimising nutrition support in patients with head and neck cancer

“…Many patients also require nutrition support through tube feeding, however the evidence remains unclear as to the optimal form of tube feeding (Nugent et al 2010b). Prophylactic gastrostomy has been recommended in some patient groups due to the beneficial effects on maintaining nutritional status or weight (Tyldesley et al 1996, Lee et al 1998, as well as other benefits such as improved quality of life (Senft et al 1993) and reduced hospital admissions , Lee et al 1998. Many of these studies were undertaken in patients receiving radiotherapy alone, and now as chemoradiotherapy treatments become standard of care, the same results for nutrition outcomes in more recent trials are not seen (Silander et al 2010).…”

“…There is no international consensus for the optimal method of tube feeding (Nugent et al, 2013), and centres have adapted either a proactive or reactive approach. The majority of studies supporting prophylactic gastrostomy insertion have been undertaken in patients receiving treatment with conformal radiotherapy or radiotherapy alone (Lee et al, 1998;Senft, Fietkau, Iro, Sailer, & Sauer, 1993;Tyldesley et al, 1996). As radiotherapy techniques and treatment regimens evolve, nutrition support recommendations also require ongoing review.…”

“…Although one additional study comparing two different centre's approaches with reactive gastrostomy placement versus proactive gastrostomy placement found a higher rate of gastrostomy dependency in the proactive placement group at three months there was no difference at six or 12 months (Olson et al, 2013). The risks of gastrostomy placement are often outweighed by the number of benefits that have been demonstrated with a prophylactic gastrostomy tube with, earlier commencement of nutrition support (Scolapio et al, 2001), reduced weight loss (Beaver et al, 2001;Tyldesley et al, 1996), improved quality of life (Fietkau, Iro, Sailer, & Sauer, 1991;Salas et al, 2009;Senft et al, 1993), and reduced admissions and healthcare costs (Hughes et al, 2013;Lee et al, 1998;Piquet et al, 2002).…”