Comparison between nasogastric tube feeding and percutaneous fluoroscopic gastrostomy in advanced head and neck cancer patients.
ABSTRACT Wasting is a major complication of advanced head and neck cancer and the aim of this study was to compare nasogastric tube feeding (NG) and percutaneous fluoroscopic gastrostomy (PFG) in these patients. The goal of these two methods of nutritional support was to improve or maintain the initial nutritional status during treatment. A total of 90 patients, all stage IV oropharynx or hypopharynx tumor, were reviewed from a prospective databank. All these patients were treated by concomitant chemotherapy and twice-daily continuous radiotherapy with no acceleration. Fifty patients were managed by PFG, and the rest by NG. Mechanical failure, duration of feeding, complications, nutritional evaluation and quality of life were analysed. Mechanical failure occurred in 32 of the 40 NG patients and in seven of the gastrostomy group. In the PFG group, 80% of patients conserved their nutritional support after the end of the radiotherapy, none patient in the NG group. In the PFG group, two presented a wound infection and six had aspiration pneumonia while in the NG group, 21 had aspiration pneumonia probably due to the NG tube (gastroesophageal reflux). The feeding methods were found to be equally effective at maintaining body weight and body mass index at time 1 (3 weeks) and at time 2 (6 weeks). Advantages were associated with PFG cosmesis, mobility and quality of life. PFG is a safe and effective method of providing enteral nutrition during treatment to patients with advanced head and neck cancer and offers important advantages over NG.
- The Laryngoscope 12/2013; · 1.98 Impact Factor
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ABSTRACT: The purpose of this study was to establish a pre-therapeutic score that could predict which patients would be at high risk of enteral tube feeding during (chemo)-radiotherapy for head and neck cancer. A monocentric study was conducted retrospectively on patients receiving a radiotherapy or concurrent chemoradiotherapy for a head and neck cancer. A logistic model was performed in order to assess clinical or therapeutic risk factors for required artificial nutrition during treatment. Significant parameters, issued from multivariate analysis, were summed and weighted in a score aiming at estimating a malnutrition risk during radiotherapy. Among the 127 evaluated patients, 59 patients required artificial nutrition during radiotherapy. In multivariate analysis, predictive factors for malnutrition were weight loss superior to 5% in the 3 months before radiotherapy, advanced tumor stage (III-IV vs. I-II), and pain requiring strong analgesics (step II-III vs. I). Concurrent chemotherapy was identified as a significant risk factor also, but it was strongly correlated with the tumor stage. The score, estimated from these previous factors, allowed a prediction of a risk of enteral feeding with a sensitivity of 90% and a specificity of 85%. A predictive score of enteral nutrition before radiotherapy of head and neck cancer should be a useful clinical tool to target the patients who would need a prophylactic gastrostomy. Our study evidenced some risk factors of malnutrition requiring artificial feeding. However, we need a prospective study to confirm the validity of this score.Cancer/Radiothérapie 10/2013; · 1.48 Impact Factor
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ABSTRACT: There are two main enteral feeding strategies-namely nasogastric (NG) tube feeding and percutaneous gastrostomy-used to improve the nutritional status of patients with head and neck cancer (HNC). But up till now there has been no consistent evidence about which method of enteral feeding is the optimal method for this patient group. To compare the effectiveness of percutaneous gastrostomy and NGT feeding in patients with HNC, relevant literature was identified through Medline, Embase, Pubmed, Cochrane, Wiley and manual searches. We included randomized controlled trials (RCTs) and non-experimental studies comparing percutaneous gastrostomy-including percutaneous endoscopic gastrostomy (PEG) and percutaneous fluoroscopic gastrostomy (PFG) -with NG for HNC patients. Data extraction recorded characteristics of intervention, type of study and factors that contributed to the methodological quality of the individual studies. Data were then compared with respect to nutritional status, duration of feeding, complications, radiotherapy delays, disease-free survival and overall survival. Methodological quality of RCTs and non-experimental studies were assessed with separate standard grading scales. It became apparent from our studies that both feeding strategies have advantages and disadvantages.Journal of Radiation Research 01/2014; · 1.45 Impact Factor