Prophylactic gastrostomy in locally advanced head and neck cancer: results of a national survey among radiation oncologists

BMC Cancer

André Van Gossum¹  Antoine Digonnet²  Sylvie Beauvois³  Tatiana Dragan³  Dirk Van Gestel³  Fréderic Duprez⁴  Yassine Lalami⁵  Akos Gulyban⁶ 

[1] Consultant at the Department of Gastroenterology and Clinical Nutrition, Hopital Erasme and Institut Jules Bordet, Brussels, Belgium;Department of Head and Neck Surgery, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium;Department of Radiation Oncology (Head and Neck Unit), Institut Jules Bordet, Université Libre de Bruxelles, 1 rue Héger Bordet – 1000 Bruxelles, Brussels, Belgium;Department of Radiotherapy-Oncology, Universitair Ziekenhuis Gent, Ghent, Belgium;Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium;Medical Physics Department, Institut Jules Bordet, Brussels, Belgium;

关键词: Endoscopic gastrostomy;    Head and neck cancer;    Radiotherapy;    Survey;   

DOI  :  10.1186/s12885-021-08348-9

来源: Springer

【 摘 要 】

BackgroundNutritional complications in patients with locally advanced head and neck cancer (LA-HNC) treated by concurrent chemoradiotherapy (CCRT) often lead to placement of a prophylactic gastrostomy (PG) tube, while indication lacks harmonization. Our aim was to explore the current PG tube utilization among Belgian radiation oncology centers.MethodsA survey was distributed to all 24 Belgian Radiation oncology departments, with questions about the number of patient treated per year, whether the PG indication is discussed at the multidisciplinary board, placement technique, time of starting nutrition and removal, its impact on swallowing function and importance of clinical factors. For the latter Relative Importance and Discordance Indexes were calculated to describe the ranking and agreement.ResultsAll 24 centers submitted the questionnaire. Twenty three treat more than 20 head and neck (HNC) patients per year, while four (1 in 21–50; 3 in 51–100) are not discussing the gastrostomy tube indication at the multidisciplinary board. For the latter, endoscopic placement (68%) is the dominant technique, followed by the radiologic (16%) and laparoscopic (16%) methods. Seventy-five percent start the enteral nutrition when clinically indicated, 17% immediately and 8% from the start of radiotherapy. Majority of specialists (19/24) keep the gastrostomy tube until the patient assume an adequate oral feeding. Fifteen centres are considering PG decrease swallowing function. Regarding factors and their importance in the decision for the PG, foreseen irradiated volume reached highest importance, followed by ‘anatomical site’, ‘patients’ choice’ and ‘postoperative versus definitive’ and ‘local expertise’, with decreasing importance respectively. Disagreement indexes showed moderate variation.ConclusionsThe use of a PG tube for LAHNC patients treated by CCRT shows disparity at national level. Prospective studies are needed to ensure proper indication of this supportive measure.

【 授权许可】

CC BY