Prophylactic percutaneous endoscopic gastrostomy in patients with nasopharyngeal carcinoma receiving concurrent chemoradiotherapy

Date 24 November 2018
Event ESMO Asia 2018 Congress
Session Poster display - Cocktail
Topics Supportive Measures
Radiation Oncology
Head and Neck Cancers
Presenter Tanadech Dechaphunkul
Citation Annals of Oncology (2018) 29 (suppl_9): ix94-ix104. 10.1093/annonc/mdy438
Authors T. Dechaphunkul1, N. Ngamphaiboon2, P. Danchaivijitr3, R. Jiratrachu4, A. Dechaphunkul5
  • 1Otorhinolaryngology Head And Neck Surgery, Songkhlanagarind Hospital, 90110 - Songkla/TH
  • 2Medicine, Division Of Medical Oncology, Ramathibodi Hospital, Bangkok/TH
  • 3Medicine, Division Of Medical Oncology, Siriraj Hospital, Mahidol University, Bangkok/TH
  • 4Radiology, Prince of Songkla University, 90110 - Hat-Yai/TH
  • 5Medicine, Division Of Medical Oncology, Prince of Songkla University, 90110 - Hat-Yai/TH

Abstract

Background

Prophylactic percutaneous endoscopic gastrostomy (PEG) is widely used for patients with head and neck cancer undergoing chemoradiotherapy (CCRT). Nevertheless, some studies showed no necessity of its use in those with nasopharyngeal carcinoma (NPC). This study aimed to evaluate the benefits of prophylactic PEG tube on prevention of weight loss and treatment tolerance in patients with NPC receiving CCRT.

Methods

A retrospective multicenter chart review of 604 patients with NPC who underwent CCRT from May 2005 to November 2014 was conducted (265 in the PEG group, and 339 in the non-PEG group). Baseline characteristics, weight loss outcome and treatment tolerance were examined and compared between the two groups. Risk factors of more than 10% weight loss during CCRT were assessed by multivariate analysis.

Results

We found significantly more T3-T4 tumors (P = 0.03), cisplatin-based regimen (P = 0.01), and less body weight before CCRT (P = 0.04) in the PEG group. Seventy-seven percent of patients in PEG group completed the planned cycles of chemotherapy, whereas only 48% of patients in the non-PEG group did (P < 0.0001). Moreover, lower percentage of weight loss during CCRT detected in the PEG group as compared to the non-PEG group, 8.9+/-8.0 kilograms (kgs) and 12.5+/-8.6 kgs, respectively (P < 0.0001). Multivariate analysis showed that obese patients (body mass index (BMI) > 25) (P < 0.0001), carboplatin-based regimen (P < 0.0001), 3-weekly chemotherapy (P = 0.01), and non-prophylactic PEG (P < 0.0001) were significantly related to ≥ 10% weight loss during CCRT.

Conclusions

Prophylactic PEG is strongly recommended for patients with NPC undergoing CCRT. Significant weight loss during CCRT should be cautiously aware for patients with obesity, receiving carboplatin or 3-weekly chemotherapy regimen and those without prophylactic PEG, hence intensive nutritional supplement is highly suggested for these groups of patients.

Editorial acknowledgement

Clinical trial identification

Legal entity responsible for the study

Research University Network: Head and Neck Study Group.

Funding

Research University Network: Thailand.

Disclosure

All authors have declared no conflicts of interest.