Evaluating Factors for Prophylactic Feeding Tube Placement in Gastroesophageal Cancer Patients Undergoing Chemoradiotherapy.

Vivek Verma,Steven H Lin,Pamela K Allen

doi:10.3389/fonc.2017.00235

Abstract

Though better studied in head/neck cancers, there are currently no studies on timing of feeding tube (FT) placement in patients with gastroesophageal cancer. This study sought to discern characteristics of patients who used versus did not use a prophylactic FT (pFT), and also analyzed factors associated with placement of FTs during chemoradiotherapy (CRT). From 1998 to 2013, 1,329 patients underwent neoadjuvant CRT, of which 323 received an FT. Patients for whom FTs were placed prior to treatment due to tumor occlusion or substantial weight loss (n = 130), and those with FTs placed following treatment (n = 43) were excluded. One hundred patients had pFTs placed, and 50 underwent placement during CRT. The following was collected for each patient: demographic/patient information, oncologic/treatment characteristics, and CRT tolerance. No significant differences were found in any parameter between cohorts that used (n = 66) versus did not use a pFT (n = 34); on univariate and multivariate analyses, no pretreatment characteristic associated with using a pFT. When compared with patients who used a pFT (n = 66), those who required an FT during CRT (n = 50) had lower body mass index (p = 0.045), underwent higher-dose radiotherapy (p = 0.003), and received induction chemotherapy (p = 0.031). On multivariate analysis, receipt of induction chemotherapy and greater weight loss and esophagitis during treatment were associated with placement of FTs during CRT (p < 0.05). Of our cohort who received pFTs, there were no clinical factors that predicted for their use. Patients must be closely monitored for weight loss and esophagitis when receiving CRT in order to intervene prior to further worsening of toxicities.

Highlights

Feeding tubes (FTs) can be used for nutritional support in cancer patients and are either placed prophylactically or as a response to toxicities during or after oncologic therapy
Exclusion criteria for this study included those patients who underwent FT insertion after RT (n = 43); though many of these were from CRTrelated toxicities, FTs in many others were placed in anticipation of surgery and not directly as a result of toxicities
The only factor associated with use of a prophylactic FTs (pFTs) was weight loss during treatment [continuous variable; odds ratio (OR) 1.16, 95% confidence interval (CI) 1.01–1.32, p = 0.03]

Summary

Introduction

Feeding tubes (FTs) can be used for nutritional support in cancer patients and are either placed prophylactically or as a response to toxicities during or after oncologic therapy. Though most commonly used in head and neck cancers, timing of use—especially prophylactically—is controversial and without consensus at present [1,2,3]. FTs are inserted much less frequently for FTs in GE Cancer gastroesophageal (GE) neoplasms. No evidence has been published to date examining factors associated with FT insertion at various time points, as well as evaluating prophylactic placement of FTs in GE cancers. The National Comprehensive Cancer Network insinuates that FT placement be considered on a case-by-case basis, especially in conditions of low caloric intake and/or esophageal obstruction [7]

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