Management of patients treated with chemoradiotherapy for head and neck cancer without prophylactic feeding tubes: The University of Pittsburgh experience

✍ Scribed by Brian T. McLaughlin; Abhay S. Gokhale; Yongli Shuai; Joyce Diacopoulos; Ricardo Carrau; Dwight E. Heron; Ryan P. Smith; Michael K. Gibson; Robert L. Ferris; Jennifer R. Grandis; Jonas T. Johnson; Athanassios Argiris

• Publisher: John Wiley and Sons
• Year: 2009
• Tongue: English
• Weight: 115 KB
• Volume: 120
• Category: Article
• ISSN: 0023-852X
• DOI: 10.1002/lary.20697

✦ Synopsis

Abstract

Objectives/Hypothesis:

Mucositis and dysphagia are common complications of chemoradiotherapy (CRT) for head and neck cancer that may necessitate nutritional support with a gastrostomy tube (G‐tube).

Methods:

We reviewed records of patients who underwent and completed CRT, which included at least one traditional chemotherapeutic, for previously untreated head and neck cancer. G‐tubes were placed as needed. The timing and duration of G‐tube placement and treatment‐related complications and risk factors for long‐term G‐tube use were analyzed.

Results:

A total of 91 consecutive patients who received CRT, 68 as primary and 23 as postoperative treatment, were studied. Radiation doses ranged from 59.4 to 74 Gy (median, 70 Gy). Seventy‐nine percent of patients received platinum‐based therapy during CRT. Severe mucositis occurred in 40% of patients. Forty percent of patients required G‐tube placement (15 prior to CRT and 21 during CRT). Median duration of G‐tube use was 5.8 months. Two patients who had a G‐tube placed during CRT developed a G‐tube‐related complication. At 6 and 12 months, 15 (18%) and four (6%) patients who were disease free were using G‐tubes, respectively. Patients with G‐tubes placed prior to CRT or advanced T stage had longer G‐tube dependence.

Conclusions:

With aggressive supportive care it is feasible to avoid G‐tubes in the majority of patients undergoing CRT for head and neck cancer. G‐tube placement prior to CRT due to pre‐existing dysphagia and advanced T stage are associated with prolonged G‐tube dependence. Laryngoscope, 2010