Hajtmanová E., Hajtman A., Kinclová I., Muríň P., Lietava P., Hajtman A., Péč M.: Percutaneous Endo­scopic Gastrostomy in the Therapy of Patients with Advanced Head and Neck Tumors


Authors: E. Hajtmanová 1;  A. Hajtman 2;  I. Kinclová 1;  P. Muríň 1;  P. Lietava 3;  A. Hajtman 4;  M. Péč 5
Authors‘ workplace: Onkologické centrum UNM, Martin, prim. MUDr. E. Hajtmanová, Ph. D. 1;  Klinika otorinolaryngológie a chirurgie hlavy a krku JLF UK a UNM, Martin, prednosta prof. MUDr. A. Hajtman, Ph. D. 2;  1. interná klinika JLF UK a UNM, Martin, prednosta prof. MUDr. M. Mokáň, DrSc. 3;  Úrad pre dohľad nad zdravotnou starostlivosťou, pracovisko Martin, riaditeľ doc. MUDr. V. Máliš, CSc. 4;  Ústav lekárskej biológie JLF UK a UNM, Martin, vedúci doc. MUDr. M. Péč, Ph. D. 5
Published in: Otorinolaryng. a Foniat. /Prague/, 60, 2011, No. 1, pp. 19-25.
Category: Original Papers

Overview

Aim:
The aim was to assess the role of percutaneous endoscopic gastrostomy (PEG) in the treatment of patients with advanced head & neck tumors.

Methods:
Patients with malignant tumors of the head and neck region are often in locally advanced stage and suffer from various degrees of malnutrition at the time of diagnosis. Toxicity of chemoradiotherapy worsens the unfavorable nutritional status and often leads to treatment gaps or even premature treatment termination. PEG was applied prophylactically to retain the nutritional status of treated patients and to mitigate the adverse reactions to radiotherapy. In the retrospective analysis we assessed the importance of percutaneous endoscopic gastrostomy that was implanted prophylactically in the treatment of 83 patients with advanced head & neck tumors. The time interval from the date of diagnosis to the start of radiotherapy treatment, the treatment gaps caused by radiotoxicity; and the loss of body weight during the treatment in the two groups of patients – with prophylactic PEG and without PEG was analyzed. At the same time we assessed the influence of these factors on the overall survival.

Results:
The time interval between the diagnosis of malignant head &neck tumor and the start of chemoradiotherapy treatment was on average 39.2 days for patients diagnosed and treated in Martin University Hospital compared to 51.7 days for patients diagnosed in different hospitals. The toxicity of concomitant chemoradiotherapy in the treatment of patients with malignancies in the head & neck region is manifested by severe odynophagia, dysphagia, xerostomia, dysgeusia and malnutrition; and it is associated with a high risk of treatment interruptions and early termination of radiotherapy. In the group of patients who had PEG during the treatment, the treatment gaps caused by acute radiotoxicity were on average 3.6 days shorter compared to patients without PEG. The weight loss was on average 4.3 kg for patients with PEG, compared to 6.9 kg in the control group of patients without PEG. The evaluation of prognostic factors – gender, age, stage, treatments gaps caused by treatment toxicity and chemoradiotherapy with prophylactic PEG implantation – showed that treatment interruptions lasting more than 5 days and chemoradiotherapy treatment without preventive PEG were significant risk factors of 3-year survival.

Conclusion:
The results confirm that PEG implanted before the start of radiotherapy treatment reduces undesired interruptions of concomitant chemoradiotherapy in patients with advanced head & neck tumors and improves the overall survival. Percutaneous gastrostomy ensures enteral nutrition and hydratation of patients during manifestation of radiochemotherapy toxicity, it reduces the body weight loss during the treatment, positively influences morbidity of patients, it decreases the need of parenteral support treatment and it allows the majority of patients to take the ambulant treatment and to retain the adequate quality of life.

Key words:
advanced H&N tumors, percutaneous endoscopic gastrostomy (PEG), chemoradiotherapy.


Sources

1. Ang, K. K., Trotti, A., Brown, B. W., Garden, A. S., Foote, R. L., Morrison, W. H., Geara, F. B., Klocht, D. W., Goepfert, H., Peters, L. J.: Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-and-neck cancer. Int. J. Radiat. Oncol. Biol. Phys., 51, 2001, 3, s. 571-578.

2. Chen, A. M., Li, B. Q., Lau, D. H., Farwell, D. G., Luu, Q., Stuart, K., Newman, K., Purdy, J. A., Vijayakumar, S.: Evaluating the role of prophylactic gastrostomy tube placement prior to definitive chemoradiotherapy for head and neck cancer. Int. J. Radiat. Oncol. Biol. Phys., 78, 2010, 4, s. 1026-1032.

3. Connor, N. P., Cohen, S. B., Kammer, R. E., Sullivan, P. A., Brewer, K. A., Hong, T. S., Chappell, R. J., Harari, P. M.: Impact of conventional radiotherapy on healt-related quality of life and critical functions of the head and neck. Int. J. Radiat. Oncol. Biol. Phys., 65, 2006, 4, s. 1051-1062.

4. Corvó, R.: Evidence-based radiation oncology in head and neck squamous cell carcinoma. Radiother. Oncol., 85, 2007, 1, s. 156-170.

5. Hujala, K., Sipilä, J., Pulkkinen, J., Grenman, R.: Early percutaneous endoscopic gastrostomy nutrition in head and neck cancer patients. Acta Otolaryngol., 124, 2004, 7, s. 847-850.

6. Hynková, L., Doleželová, H.: Nežádoucí účinky rádioterapie a podpůrná léčba u rádioterapie nádorů hlavy a krku. Onkologie, 2, 2008, 2, s. 88-90.

7. Idowu, O., Driggs, X. A., Kim, S.: Laparoscopically assisted antegrade percutaneous endoscopic gastrostomy. J. Pediatr. Surg., 45, 2010, 1, s. 277-279.

8. Jensen, A. R., Nelleman, H. M., Overgaard, J.: Tumor progression in waiting time for radiotherapy in head and neck cancer. Radiother. Oncol., 84, 2007, 1, s. 5-10.

9. Lee, J. H., Machtay, M., Unger, L. D., Weinstein, G. S., Weber, R. S., Chalian, A. A., Rosenthal, D. I.: Prophylactic gastrostomy tubes in patients undergoing intensive irradiation for cancer of the head and neck. Arch. Otolaryngol. Head Neck Surg., 124, 1998, 8, s. 871-875.

10. Mechl, Z., Smilek, P., Červená, R.: Současná strategie léčby karcinomů ORL oblasti. Klin. Onkol., 21, 2008, 2, s. 45-51.

11. Morton, R. P., Crowder, V. L., Mawdsley, R., Ong, E., Izzard, M.: Elective gastrostomy, nutritional status and quality of life in advanced head and neck cancer patients receiving chemoradiotherapy. ANZ J. Surg., 79, 2009, 10, s. 713-718.

12. Nguyen, N. P., North, D., Smith, H. J., Dutta, S., Alfieri, A., Karlsson, U., Lee, H., Martinez, T., Lemanski, C., Nguyen, L. M., Ludin, A., Sallah, S.: Safety and effectivenes of prophylactic gastrostomy tubes for head and neck cancer patients undergoing chemoradiation. Surg. Oncol., 15, 2006, 4, s. 199-203.

13. Pála, M.: Komentář. Lancet Oncol., české vydání, 5, 2006, 2, s. 160.

14. Petera, J., Odrážka, K., Zouhar, M. et al.: Principy radioterapie. In: Šlampa, P., Petera, J. et al. Radiační onkologie. Praha, Galén Karolinum, 2007, s. 11-65.

15. Rutter, C. E., Yovino, S., Taylor, R. et al.: Early PEG tube placement improves nutritional status and decreases hospitalization in head and neck cancer patients receiving definitive chemoradiation. Int. J. Radiat. Oncol. Biol. Phys., 75, 2009, 3, (Suppl.), s. S123-S133.

16. Saarilahti, K., Kajanti, M., Lehtonen, H., Hämäläinen, T., Joensuu, H.: Repopulation during radiotherapy for T1 glottic cancer. Radiother. Oncol., 47, 1998, 2, s. 155-159.

17. Suwinski, R., Sowa, A., Rutkowski, T., Wydmanski, J., Tarnawski, R., Maciejewski, B.: Time factor in postoperative radiotherapy: a multivariate locoregional control analysis in 868 patients. Int. J. Radiat. Oncol. Biol. Phys., 56, 2003, 2, s. 399-412.

18. Šachlová, M.: Výživa onkologických pacientů. Klin. Onkol., 16, 2003, 2, s. 77-79.

19. Šlampa, P., Soumarová, R., Kocáková, I. et al.: Konkomitantní chemorádioterapie solidních nádorů. Praha, Galén, 2005, 167 s.

20. Wasiková, S., Piskač, P., Spurný, V., Rotnáglová, S.: Perkutánní endoskopická gastrostomie u pacientů s tumory hlavy a krku. Klin. Onkol., 20, 2007, 5, s. 349-353.

21. Zips, D.: Influence of time factor and repopulation on treatment resistance. In: Molls, M., Vaupel, P., Nieder, C., Anscher, M. S.: The impact of tumor biology on cancer treatment and multidisciplinary strategies. Berlin, Springer, 2009, s. 292-296.

Labels
Audiology Paediatric ENT ENT (Otorhinolaryngology)

Article was published in

Otorhinolaryngology and Phoniatrics

Issue 1

2011 Issue 1

Most read in this issue

This topic is also in:


Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account