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Jason H. Lee, MD; Mitchell Machtay, MD; Lisa D. Unger, MD; Gregory S. Weinstein, MD; Randal S. Weber, MD; Ara A. Chalian, MD; David I. Rosenthal, MD

Arch Otolaryngol Head Neck Surg. 1998;124:871-875.

Background  Most patients receiving accelerated fractionation radiotherapy or chemoradiotherapy for head and neck cancer experience severe mucositis. This can lead to decreased oral intake, resulting in dehydration, severe malnutrition, hospitalization, and/or interruption of radiotherapy.

Objective  To evaluate the effect of prophylactic gastrostomy tubes (PGTs) on the rates of weight loss, unplanned interruptions, and hospitalization during high-intensity head and neck radiotherapy.

Methods  A retrospective review was performed on 88 patients treated for locally advanced head and neck cancer with accelerated twice-a-day radiation (n = 59) or concurrent chemoradiotherapy (n = 29). Prophylactic gastrostomy tubes were placed in 36 (41%) of patients in anticipation of increased acute toxic effects from treatment. The remaining patients without PGTs served as a control group.

Results  Patients without PGTs lost an average 3.1 kg compared with 7.0 kg in the control group (P<.001). There were significantly fewer hospitalizations for nutritional or dehydration issues in those with PGTs than in the control group (13% vs 34%; P = .04, ² test). Among those with good performance status, no patient with a PGT required a treatment interruption, compared with 18% of patients without a PGT (P = .08). Sixteen patients (31%) in the control group underwent therapeutic gastrostomy tube placement during or after radiation therapy.

Conclusions  The use of PGTs significantly reduces weight loss and the rate of hospitalization for dehydration and complications of mucositis. Treatment interruptions may also be avoided by the use of PGTs in patients with good performance status. We encourage patients scheduled for intensive radiation therapy to receive a PGT.

From the Department of Radiation Oncology (Drs Lee, Machtay, and Rosenthal), Clinical Nutrition Support Services (Dr Unger), and Department of Otorhinolaryngology (Drs Weinstein, Weber, and Chalian), University of Pennsylvania Medical Center, Philadelphia.

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