Utilization of gastrostomy tubes during chemoradiotherapy for head and neck cancer: The University of Pittsburgh experience

Abstract

20657 Background: Mucositis and dysphagia are common complications of CRT for HNC that may necessitate nutritional support with a gastrostomy tube (G-tube). Our institutional policy is to recommend against prophylactic G-tubes unless patients (pts) have progressive weight loss and dysphagia prior to CRT initiation. Progressive weight loss of >10–15% and/or severe dysphagia are indications for G-tube placement during CRT. Methods: We reviewed records of pts who underwent and completed CRT with curative intent, which included at least one traditional chemotherapeutic, for previously untreated HNC of any histology at a University hospital practice from 5/05 to 6/07. The timing and duration of G-tube placement as well as treatment-related complications were noted. Supportive care included close monitoring by an experienced team, swallowing exercises, opioid analgesics, mouth care, and intravenous hydration. Results: We identified and analyzed a total of 80 pts who received CRT; 59 as primary therapy (27 with induction therapy) and 21 as postoperative. Characteristics: 73/80 pts had squamous cell carcinoma; stage II, 1; stage III, 19; stage IV, 60; median age 57 years (20–82). Primary site: oral cavity, 19; oropharynx, 27; larynx, 12; hypopharynx, 5; nasopharynx, 7; unknown, 3; other, 7. RT doses ranged from 59.4–74 Gy (median 70 Gy). CRT regimens included cisplatin with or without cetuximab, 50; carboplatin, 11; cisplatin/paclitaxel, 3; pemetrexed/cetuximab, 14; docetaxel/erlotinib, 2. Grade 3 mucositis developed in 39% of pts. 33 G-tubes (41%) were placed (15 prior to CRT and 18 during CRT); 32 via percutaneous endoscopic gastrostomy; site infection or tube displacement occurred in 3 cases; esophageal dilatations were performed in 6 pts. Of 65 pts without prophylactic G-tubes, 18 (28%) required G-tube placement during CRT at a median of 30 days (17–41); median weight loss was 12% from baseline; 7/18 (39%) were in place at 6 months and 1 (6%) at 12 months. 8/15 pts (53%) who had prophylactic G-tubes required its use 12 months later. Conclusions: With aggressive supportive care, it is feasible to avoid G-tubes in the majority of pts undergoing CRT for HNC. Pts who require G-tube placement during CRT are unlikely to remain long-term dependent on G-tube use. No significant financial relationships to disclose.