Prophylactic Gastrostomy in Locally Advanced Head and Neck Cancer: Results of a National Survey Among Radiation Oncologists

Overview

Journal BMC Cancer

Publisher Biomed Central

Specialty Oncology

Date 2021 Jun 3

PMID 34078309

Citations 4

Authors

Tatiana Dragan

Frederic Duprez

Andre Van Gossum

Akos Gulyban

Sylvie Beauvois

Antoine Digonnet

Yassine Lalami

Dirk Van Gestel

Affiliations

Soon will be listed here.

Abstract

Background: Nutritional complications in patients with locally advanced head and neck cancer (LA-HNC) treated by concurrent chemoradiotherapy (CCRT) often lead to placement of a prophylactic gastrostomy (PG) tube, while indication lacks harmonization. Our aim was to explore the current PG tube utilization among Belgian radiation oncology centers.

Methods: A survey was distributed to all 24 Belgian Radiation oncology departments, with questions about the number of patient treated per year, whether the PG indication is discussed at the multidisciplinary board, placement technique, time of starting nutrition and removal, its impact on swallowing function and importance of clinical factors. For the latter Relative Importance and Discordance Indexes were calculated to describe the ranking and agreement.

Results: All 24 centers submitted the questionnaire. Twenty three treat more than 20 head and neck (HNC) patients per year, while four (1 in 21-50; 3 in 51-100) are not discussing the gastrostomy tube indication at the multidisciplinary board. For the latter, endoscopic placement (68%) is the dominant technique, followed by the radiologic (16%) and laparoscopic (16%) methods. Seventy-five percent start the enteral nutrition when clinically indicated, 17% immediately and 8% from the start of radiotherapy. Majority of specialists (19/24) keep the gastrostomy tube until the patient assume an adequate oral feeding. Fifteen centres are considering PG decrease swallowing function. Regarding factors and their importance in the decision for the PG, foreseen irradiated volume reached highest importance, followed by 'anatomical site', 'patients' choice' and 'postoperative versus definitive' and 'local expertise', with decreasing importance respectively. Disagreement indexes showed moderate variation.

Conclusions: The use of a PG tube for LAHNC patients treated by CCRT shows disparity at national level. Prospective studies are needed to ensure proper indication of this supportive measure.

Citing Articles

Revalidation of Proactive Gastrostomy Tube Placement Guidelines for Head and Neck Cancer Patients Receiving Helical Intensity-Modulated Radiotherapy.

Brown T, Byrnes A, Chan A, Dwyer K, Edwards A, Blake C Curr Oncol. 2024; 31(11):6938-6955.

PMID: 39590143 PMC: 11592900. DOI: 10.3390/curroncol31110512.

Multidisciplinary survey on use of feeding tubes in head and neck cancer patients undergoing chemoradiotherapy in Germany-the SUFEETUBE project.

Loser A, Fabian A, Ruhle A, Thieme A, Baehr A, Kasmann L Strahlenther Onkol. 2024; 200(7):583-594.

PMID: 38381142 PMC: 11186953. DOI: 10.1007/s00066-024-02206-w.

Percutaneous gastrostomies in advanced cancer.

Ferraz-Goncalves J, Amaral S, Pereira F, Santos L, Assis J, Alves S Porto Biomed J. 2023; 8(6):e238.

PMID: 38093796 PMC: 10715762. DOI: 10.1097/j.pbj.0000000000000238.

Patient-reported outcomes in terms of swallowing and quality of life after prophylactic versus reactive percutaneous endoscopic gastrostomy tube placement in advanced oropharyngeal cancer patients treated with definitive chemo-radiotherapy: Swall....

Dragan T, Van Gossum A, Duprez F, Lalami Y, Lefebvre Y, Mootassim-Billah S Trials. 2022; 23(1):1036.

PMID: 36539781 PMC: 9768988. DOI: 10.1186/s13063-022-06991-6.

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