The role of pretreatment percutaneous endoscopic gastrostomy in facilitating therapy of head and neck cancer and optimizing the body mass index of the obese patient Journal Article

Authors: Raykher, A.; Correa, L.; Russo, L.; Brown, P.; Lee, N.; Pfister, D.; Gerdes, H.; Shah, J.; Kraus, D.; Schattner, M.; Shike, M.
Article Title: The role of pretreatment percutaneous endoscopic gastrostomy in facilitating therapy of head and neck cancer and optimizing the body mass index of the obese patient
Abstract: Background: Chemoradiation of head and neck cancer induces severe dysphagia and malnutrition, which may lead to interruptions in therapy and reduction in its efficacy. Percutaneous endoscopic gastrostomy (PEG) feedings bypass the oropharynx, allowing administration of nutrients and medications into the stomach, thus preventing malnutrition, dehydration, and treatment interruption. Methods: Medical records of 161 patients treated for head and neck cancer who had PEGs placed prior to chemoradiation and 2 PEGs placed during chemoradiation were reviewed from the date of PEG placement throughout treatment and utilization. The objective was to determine the contribution of pretreatment PEGs to the therapy of patients with head and neck cancer and to optimize their body mass index. Results: Severe chemoradiation-induced dysphagia developed in 160 patients (98%), necessitating PEG utilization for feeding and hydration. PEGs were used for a mean 251 ± 317 days. Significant complications related to PEG placement and utilization were infrequent. PEG feeding allowed chemoradiation to continue without interruption in 93% of patients. Individualized feeding regimens optimized body mass index in obese and overweight patients with a decline from 33.0 ± 3.4 to 28.4 ± 4.8 kg/m<sup>2</sup> (P &lt;.001) and 27.3 ± 1.5 to 24.6 ± 2.7 kg/m<sup>2</sup> (P &lt;.001), respectively. Radiation-induced strictures developed in 12% of patients, requiring endoscopic dilatation. Conclusions: Enteral feeding through prechemoradiation-placed PEGs is an effective and safe method for nutrition and hydration of patients with head and neck cancer undergoing chemoradiation. PEGs allowed chemoradiation to proceed with minimal interruptions despite severe dysphagia, which excluded oral intake for prolonged periods. © 2009 American Society for Parenteral and Enteral Nutrition.
Keywords: adult; cancer chemotherapy; aged; aged, 80 and over; middle aged; antibiotic agent; cancer surgery; retrospective studies; young adult; major clinical study; constipation; disease course; percutaneous endoscopic gastrostomy; cisplatin; fluorouracil; diarrhea; treatment duration; cancer radiotherapy; combined modality therapy; outcome assessment; carboplatin; pain; obesity; medical record review; oncology; risk assessment; abdominal pain; dysphagia; body mass; body mass index; narcotic analgesic agent; head and neck cancer; head and neck neoplasms; proton pump inhibitor; surgical infection; nausea and vomiting; oropharynx cancer; thyroid cancer; antiemetic agent; dermatitis; malnutrition; gastroesophageal reflux; postoperative hemorrhage; nasopharynx cancer; tongue cancer; analgesia; ileus; larynx cancer; esophagus stricture; gastroscopy; hydration; deglutition disorders; mouth cancer; gastrostomy; dilatation; aspiration pneumonia; analgesic agent; digestive tract endoscopy; mouth pain; chemoradiation treatment; enteral nutrition; antidiarrheal agent; enteric feeding; hypopharynx cancer; oropharyngeal pain; pharynx cancer; sore throat; intubation, gastrointestinal
Journal Title: Journal of Parenteral and Enteral Nutrition
Volume: 33
Issue: 4
ISSN: 0148-6071
Publisher: Sage Publications  
Date Published: 2009-07-01
Start Page: 404
End Page: 410
Language: English
DOI: 10.1177/0148607108327525
PUBMED: 19520799
PROVIDER: scopus
Notes: --- - "Cited By (since 1996): 4" - "Export Date: 30 November 2010" - "CODEN: JPEND" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Moshe Shike
    119 Shike
  2. Hans Gerdes
    139 Gerdes
  3. Dennis Kraus
    265 Kraus
  4. Nancy Y. Lee
    582 Lee
  5. David G Pfister
    270 Pfister
  6. Mark Schattner
    110 Schattner
  7. Jatin P Shah
    566 Shah
  8. Lianne M Russo
    17 Russo
  9. Patricia A Brown
    6 Brown