Enteral nutrition support in head and neck cancer: Tube vs. oral feeding during radiation therapy

Abstract

This comparison of tube feeding with oral nutrition was made in patients with advanced head and neck cancer during intensive outpatient radiation therapy. Twenty-six patients with Stage III and IV head and neck cancers were stratified by site (nasopharynx vs. all other tumors, including recurrent nasopharynx) and randomized to receive oral or tube feeding during radiation therapy. All patients were counseled to have an intake of 40 kcal/kg and 1 gm protein per kilogram body weight. Body weights and dietary recalls were obtained weekly, along with evaluation of toxicities to therapy. Serum albumins were obtained at baseline, week 4, end of radiation therapy, and 1 month after radiation therapy. Patients with nasopharyngeal carcinoma presented with significantly less body weight loss (means = -2.6%) than patients with all other carcinomas (means = -9.8%; p = .008). No differences in toxic responses were observed despite larger radiation field size in the tube-fed group (p = .02). Serum albumins in both groups dropped during radiation therapy, with no difference between groups. The tube-fed group maintained higher caloric and protein intakes (35 to 42 kcal/kg, 1.2 to 1.6 gm protein per kilogram) than the oral-fed group (15 to 34 kcal/kg, 0.3 to 1.3 gm protein per kilogram). No differences in body weights were observed between the tube-fed (means = 3.8%) and the oral-fed (means = 3.3%) patients with nasopharyngeal carcinoma. Patients with oropharyngeal and recurrent nasopharyngeal carcinoma had significantly less weight loss with tube feeding (means = 0.2%) than with oral feeding (means = -7.3%; p = .005); thus, tube feeding is recommended during radiation therapy in such patients.