Purpose: A majority of the patients with a diagnosis of locally advanced head and neck cancer receiving combined chemoradiotherapy experience mucositis, odynophagia, and dysphagia resulting in reduced oral intake and weight loss during the treatment. A prophylactic feeding tube is generally recommended for these patients to maintain body weight during the treatment. The purpose of this retrospective study is to understand the change in body weight from baseline to last follow-up after completion of radiotherapy or combined chemoradiotherapy and to assess the role of prophylactic feeding tube placement in maintaining body weight.
Methods: Thirty-seven patients with a diagnosis of locally advanced head and neck cancers were treated either with adjuvant or definitive radiotherapy with or without chemotherapy at Kansas City VA Medical Center during 2013. Eleven patients did not receive chemotherapy, and a majority of the patients did not receive prophylactic percutaneous endoscopic gastrostomy tube placement. Twenty-six patient received cisplatin-based chemotherapy during radio-therapy; of these, 9 patients had no feeding tube and 17 patients received a prophylactic feeding tube. The radiation dose ranged from 60 to 70 Gy in 30 to 35 fractions. All these patients were followed on a regular basis, and weights were recorded on each visit. The follow-up period ranged from a minimum of 6 months to a maximum of 18 months. Results: Five patients died either from locoregional recurrence or distant metastases. The average weight loss for patients with combined modality treatments was 9.7% vs 6.3% for patients receiving no chemotherapy. The average weight loss for patients receiving concurrent chemotherapy and with prophylactic feeding tube placement was 7.4% com-pared with average weight loss of 16% for patients receiving chemotherapy and no prophylactic feeding tube placement. The majority of these patients both in the chemotherapy and the no chemotherapy groups never regained their baseline weight.
Conclusions: Patients receiving chemotherapy benefited from prophylactic feeding tube placement in maintaining body weight similar to patients receiving no chemotherapy.
