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

Czech version

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: Otorinolaryngol Foniatr, 60, 2011, No. 1, pp. 19-25.
Category: Original Article

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.

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