Prophylactic PEG Placement Prevents Exacerbation of Weight Loss during Chemo-Radiation for Head and Neck Cancer Patients

Abstract

Purpose: In addition to generalized risk factors of anorexia and cachexia, head and neck cancer patients receiving chemo-radiation therapy are at risk for significant weight loss secondary to mucositis and the odynophagia/dysphagia caused by radiation injury to the esophagus. It is routine practice to prophylactically place a percutaneous endoscopic gastrostomy tube prior to the initiation of chemo-radiation in this population. The value of prophylactic placement has been questioned as some patients never require to utilize the PEG after it has been placed. Outcome parameters of PEG placement were studied in head and neck cancer patients referred routinely for a PEG prior to chemo-radiation. Specifically, we were focused on whether patients utilized the PEG at all for maintenance of hydration or nutrition, and if so, whether utilization of the PEG allowed patients to maintain their weight compared to patients who did not use the PEG. Methods: A retrospective chart review was performed on 34 consecutive patients who underwent PEG placement prior to beginning combination chemo-radiation for head and neck cancers. Use of the PEG tube and body weights were assessed 12 to 16 weeks after initiation of therapy. The same attending gastroenterologist supervised PEG placement and follow up of each patient. Results: 5 patients were lost to follow-up, allowing for analysis of 29 patients. 6/29 (20.7%) patients did not end up using the PEG at all for hydration or nutrition. 7/29 (24.1%) patients used the PEG exclusively, due to severe limitations of oral intake. 16/29 (55.2%) patients used the PEG to supplement limited oral intake. Over all average weight loss was 8.0 kg per patient; a reduction in usual body weight (UBW) of 9.9%. Among the patients who never used their PEG the average weight loss was 8.7 kg; a reduction in UBW of 10.3%. Of the patients who used the PEG exclusively, the average weight loss was 8.6 kg; a reduction in UBW of 10.7%. Conclusions: The routine prophylactic placement of a PEG tube prior to chemo-radiation for head and neck cancer patients was utilized to some extent by the majority of patients (79.3%). Patients utilizing the PEG tubes to overcome limitations in oral intake secondary to the chemo-radiation were able to maintain their weight as well as patients who did not experience any limitations in oral intake secondary to the therapy. This data supports the routine placement of PEG tubes prior to chemo-radiation for head and neck cancer patients.