Gastrostomy tube placement in head and neck cancer patients undergoing radiotherapy

  • 1/24/2005
  • R Moore
  • J Hum Nutr Diet, December 1, 2004; 17(6): 578

Background:
In head and neck cancer (HNC) patients, the side effects of radiotherapy (RT) often lead to patients being unable to consume adequate nutrition and fluid (Chencharick and Mossman, 1983). Gastrostomy tube placement prior to RT can reduce incidence of severe weight loss and hospitalization during treatment (Beaver et al., 2001). However, gastrostomy tube usage is dependant upon HNC site and area of RT. The aims of the study were to identify the characteristics of those HNC patients who will require gastrostomy tube feeding during RT and utilize these data to target future patients for prophylactic tube placement prior to commencing RT and to write guidelines for the placement of feeding tubes.

Method:
Data were collected retrospectively regarding diagnosis, surgery and area of RT on all HNC patients who had had a prophylactic gastrostomy placed prior to RT between April 2000 and April 2002. Outcome measurements in terms of utilization of gastrostomy, body weight and nutrition related emergency admissions were recorded. Results: Thirty-five patients had a prophylactic gastrostomy placed [26 male, nine female; mean age 62 (range 26-84) years]. Of these, 26 utilized their tube for feeding or fluids during RT. The sites of radiotherapy were: bilateral RT to the oro- or nasopharynx and neck (20 patients), bilateral RT to the neck (five) and RT to the left oropharynx and neck (one). The mean weight loss during RT in patients who utilized their prophylactic gastrostomy was 3.3 (range 0-11.5%) compared to 8 (5.5-12.0%) in patients who did not have a prophylactic gastrostomy. Only one of the patients with a prophylactic gastrostomy had a hospital admission (length of stay 11 days) compared to four patients who did not [mean length of stay 21 days (range 14-29)]. Six of the nine patients who did not utilize their gastrostomy for feeding and were able to maintain their nutrition orally, received bilateral RT to the neck only.

Discussion:
Most of the patients who received bilateral RT to the oro- or nasopharynx required gastrostomy feeding during RT, which is consistent with findings of Beaver et al. (2001) who reported the highest incidence of weight loss in patients receiving RT to the nasopharynx or base of the tongue.

Conclusion:
In view of the association between the site of RT and gastrostomy utilization, hospital admissions, length of stay and weight loss, HNC patients with planned bilateral RT to the oro- or nasopharynx or with existing dysphagia should be targeted for gastrostomy tube placement prior to starting treatment.

References:
Beaver, M.E., Matheny, K.E., Roberts, D.B. & Myers, J.N.(2001) Predictors of weight loss during radiation therapy. Otolaryngol. Head Neck Surg. 125, 645-648.
Chencharick, J.D. & Mossman, K.L. (1983) Nutritionalconsequences of the radiotherapy of head and neck cancer. Cancer 51, 811-815.