Prophylactic PEG Tube and Swallowing following Chemoradiation in Head and Neck Cancer Patients

Abstract

Objectives: (1) Compare swallowing status in patients receiving a prophylactic gastrostomy (PPEG) tube versus relying on oral intake during chemoradiation (CRT) for head and neck cancer. (2) Discuss prognostic factors associated with gastrostomy tube dependence 1 year after completion of CRT. Methods: The Eastern Virginia Medical School Cancer registry identified patients with a new head and neck cancer diagnosis from January 1, 2001, to July 1, 2008. We excluded patients treated with primary surgical therapy, at an outside facility, and with radiation therapy only. Our final cohort of patients who lived at least 1 year with follow-up was 105. Primary outcomes were oral intake status at 1 year and need for esophageal dilation. Results: Eighty-one patients received a PPEG, and 24 did not. There was no difference in swallowing function at 6 months ( P = .27) or the rate of esophageal dilation ( P = .22). Stricture rates were 13% in the initial oral group versus 25% in the PPEG group. Univariate analysis predictors for PEG tube dependence at 1 year were Zubrod score >1 ( P < .001), PPEG ( P = .03), and higher T stage ( P = .008). On multivariate analysis, PPEG ( P = .05), Zubrod score >1 ( P = .000001), and higher T stage ( P = .02) were independent predictors for PEG tube dependence at 1 year. Conclusions: PPEG tube, Zubrod score >1, and higher T stage were independent predictors for PEG tube dependence after chemoradiation. An approach of initial oral intake with placement of therapeutic PEG due to inability to maintain adequate nutrition by mouth should be considered.