Enteral nutrition during the treatment of head and neck carcinoma - Is a percutaneous endoscopic gastrostomy tube preferable to a nasogastric tube?

BACKGROUND. Multimodality treatments for patients with squamous cell head a nd neck carcinoma often produce significant mucositis and dysphagia, mandat ing enteral nutritional support. Patient preference has resulted in the inc reasing use of percutaneous endoscopic gastrostomy (PEG) tubes rather than nasogastric (NG) tubes. Anecdotal observations of prolonged PEG dependence and of a need for pharyngoesophageal dilatation in PEG patients prompted a retrospective review of the use of both types of feeding tubes. METHODS. Patients who were treated on clinical trials of radiotherapy or ch emoradiotherapy for squamous cell head and neck carcinoma between 1989 and 1997 were reviewed retrospectively. Data were gathered regarding demographi cs, primary tumor site, T and N classifications, and the need for feeding t ube placement. In patients requiring feeding tubes, the type and duration o f the feeding tube, the need for tracheostomy, the need for pharyngoesophag eal dilatation, and the degree of mucositis and dysphagia at baseline and a t 1 month, 3 months, 6 months, and 12 months after beginning treatment were recorded. Comparisons were then made between the NG and the PEG groups. RESULTS. Ninety-one feeding tubes were placed in 158 patients over the 8-ye ar interval. A hypopharyngeal primary site, female gender, a T4 primary tum or, and treatment with chemoradiotherapy were predictive of a need for feed ing tube placement. NG tubes were placed in 29 patients, and PEG tubes were placed in 62 patients. PEG patients had more dysphagia at 3 months (59% vs . 30%, respectively; P = 0.015) and at 6 months (30% vs. 8%, respectively; P = 0.029) than NG patients. The median tube duration was 28 weeks for PEG patients compared with 8 weeks for NG patients, (P < 0.001). Twenty-three p ercent of PEG patients needed pharyngoesophageal dilatation compared with 4 % of NG patients (P = 0.022). These end points could not be correlated with age, stage, primary tumor site, or tracheostomy placement. CONCLUSIONS. Although patients treated for head and neck carcinoma find tha t the PEG tube is a more acceptable route for enteral nutrition than the NG tube, in the authors' experience, a PEG tube was required for longer perio ds of time and was associated with more persistent dysphagia and an increas ed need for pharyngoesophageal dilatation. A randomized prospective trial i s needed to test these observations. (C) 2001 American Cancer Society.