Tube feeding enteral nutritional support in patients receiving radiation therapy for advanced head and neck cancer |
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| Authors: | R D Pezner J O Archambeau J A Lipsett W A Kokal W Thayer L R Hill |
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| Affiliation: | 1. Division of Radiation Oncology, Duarte, CA 91010, USA;2. Department of Radiobiology and Radiation Research, Loma Linda University Medical Center, Loma Linda, CA 92354 USA;3. Department of General and Oncologic Surgery, Duarte, CA 91010, USA;4. Department of General and Consultative Medicine, Duarte, CA 91010, USA;5. Department of Biostatistics, City of Hope National Medical Center, Duarte, CA 91010, USA;1. Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, Minnesota, USA;2. Department of Medicine, Division of Nephrology, Hennepin County Medical Center, Minneapolis, Minnesota, USA;3. Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA;1. University of Queensland, Australia;2. Australian National University, Australia;1. The University of Leicester Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester, RKCSB, Leicester, United Kingdom;2. Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom;3. Addenbrooke''s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom;4. Division of Ophthalmology and Orthoptics, Health Sciences School, University of Sheffield, United Kingdom;1. Óbuda University, Budapest, Hungary;2. Institute of Materials and Environmental Chemistry, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary |
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| Abstract: | A retrospective study evaluated the role of tube feeding enteral nutritional support in patients receiving radiation therapy (RT) for Stage III and IV squamous cell carcinoma of the head and neck. Tube feeding (TF) by either nasogastric, cervical esophagostomy, or gastrostomy route was based on individual physician preference and patient acceptance. TF feeding starting before and continuing through RT (planned TF) was completed in 17 patients, whereas 9 patients did not receive TF until they lost weight during RT (interventional TF). No tube feeding was performed in 63 patients. By the end of RT, the planned TF group lost an average of 4.8% of initial body weight, compared to 7.1% in the no TF group and 9.4% in the interventional TF group. At the end of RT, only 6% of the planned TF group had lost over 10% of initial body weight, compared to 24% of the no TF group and 44% of the interventional group. Excluding patients who continued to lose weight after the end of RT due to rapidly recurrent tumor, 49% of the no TF group had a post-RT nadir weight loss over 10% of initial body weight, compared to 0% of the planned RT group. However, failure to receive the full RT dose and/or lengthy rest periods during RT were just as likely to occur in the planned TF group as in the no TF group. This retrospective review also could not demonstrate improved survival in the planned TF group. Complications, including peptic ulcer disease, aspiration pneumonia, cervical stoma abscess, and hepatic encephalopathy, occurred in 7 of the 26 patients (27%) receiving either planned or interventional TF. We conclude that TF will help minimize weight loss due to side effects of RT for head and neck cancer, particularly when TF is instituted before the onset of significant weight loss due to RT side effects. Survival differences, however, were not apparent. |
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