Effectiveness of Prophylactic Gastrostomy in Head and Neck Cancer Patients Treated by Image-Guided Radiotherapy and Chemotherapy: Practice Proposal by the International Geriatric Radiotherapy Group

Author(s): Nam P Nguyen, Paul Vos, Jacqueline Vock, Juliette Thariat, Richard A Vo, Sarah Kratz, Michelle Bratton, Claire Lemanski, Vincent Vinh-Hung, Olena Gorobets, Alexander Chi, Juan Godinez, Michael Betz

Objectives: To assess the effectiveness of prophylactic percutaneous endoscopic gastrostomy (PEG) tube feedings in locally advanced head and neck cancer patients undergoing image-guided radiotherapy (IGRT) and concurrent chemotherapy.

Materials and Methods: A retrospective review of 141 patients with locally advanced head and neck cancer who underwent concurrent chemoradiation using IGRT was performed. Prophylactic PEG placement was performed in 101 patients while 40 patients declined PEG. Grade 3-4 acute toxicities, treatment breaks, and weight loss were compared between the two groups.

Results: Mean weight loss was 11.4 and 15 pounds (p=0.06) for patients with and without PEG respectively. Mean treatment breaks was 8.1 and 7.4 days (p=0.6) for patients with and without PEG respectively. Both groups experienced significant grade 3-4 toxicity. Grade 3-4 hematologic toxicity and mucositis were 20% and 21% (p=0.8), and 75% and 80% (p=0.1) for the group with and without PEG respectively. Seven patients (4.8%) developed aspiration pneumonia (five with PEG and two without PEG). No patient had any complications related to PEG placement.

Conclusions: Grade 3-4 toxicity remains significant for head and neck cancer patients undergoing IGRT and chemotherapy leading to severe weight loss, treatment breaks, and aspiration pneumonia. Prophylactic PEG placement is safe to complement oral intake. Close patient monitoring and nutritional support should be provided regardless of the PEG status. Future prospective studies should be conducted to assess the impact of PEG on patient nutrition and quality of life in a larger number of patients with head and neck cancer.