2313 - Impact of Timing and Technique of Gastrostomy Placement on the Outcome of Patients (pts) with Head and Neck Cancer (HNC)

Background

Nutritional status affects survival of pts with HNC. Close to half HNC pts require enteral nutrition, with percutaneous endoscopic gastrostomy (PEG) being the preferred route. We studied whether PEG placement technique and timing impact on HNC pts outcomes.

Methods

We retrospectively analyzed all HNC pts who underwent PEG insertion between February 2014 and August 2018 at Vall d´Hebron University Hospital. The primary objectives were to assess overall survival (OS) and PEG complication rate in light of nutritional parameters (albumin, cholesterol and PCR) and disease stage (local and locally-advanced [LA] vs recurrent-metastatic [R/M]) when PEG is placed in a prophylactic (P-PEG) or symptomatic (S-PEG) setting with endoscopic or radiologic intervention.

Results

Out of 125 pts, 52% had LA disease and 48% R/M, 37% had P-PEG, 63% S-PEG [tumor related symptoms (61%), treatment toxicity (30%), nasogastric tube intolerance or dysfunction (6%), and other feeding disorders (3%)]. High albumin and cholesterol levels associated with better of OS [HR = 0.64 (CI 95% 0.42-0.98), p = 0.04 and HR = 0.65 (CI 95% 0.43-0.99), p = 0.04, respectively]. In the R/M setting, no difference in median OS was observed between P-PEG 18.9 months (m) (CI 95% 12.7-45) and S-PEG 15.6 m (CI 95% 11.5-22.2, HR = 0.89, CI 95% 0.57-1.4, p = 0.62). In the LA setting, we found numerically longer median OS in pts with P-PEG 42.2 m (CI 95% 21.9-NA) vs PEG-S 16.2 m (CI 95% 11.5-NA, HR = 0.72, CI 95% 0.37-1.94, p = 0.33). Complication rate was 28% in the P-PEG group vs 30% S-PEG group (p = 0.8). Most common complications included infection 35%, ileus and delayed gastric emptying (22%), and bronchial aspiration (13%). Complications led to treatment interruption in 4 pts (3.2%). Complication rate was lower in LA setting than in R/M setting (24% vs 35%, p = 0.2). Endoscopic PEG placement was associated with less complications (9%) than radiologic placement (47%, p = 0.08).

Conclusions

We confirmed that nutritional parameters impact on HNC pts OS. In the LA setting, P-PEG might be associated with a better outcome. Endoscopic PEG placement appears to be related to fewer complications. Our results will help design a PEG placement algorithm to further evaluate the role of P-PEG.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

J. Tabernero: Advisory / Consultancy: Arrays Biopharma; Advisory / Consultancy: AstraZeneca; Advisory / Consultancy: Bayer; Advisory / Consultancy: BeiGene; Advisory / Consultancy: Boehringer Ingelheim; Advisory / Consultancy: Chugai; Advisory / Consultancy: Genentech; Advisory / Consultancy: Inc; Advisory / Consultancy: Genmab A/S; Advisory / Consultancy: Halozyme; Advisory / Consultancy: Imugene Limited; Advisory / Consultancy: Inflection Biosciences Limited; Advisory / Consultancy: Ipsen; Advisory / Consultancy: Kura Oncology; Advisory / Consultancy: Lilly; Advisory / Consultancy: MSD; Advisory / Consultancy: Menarini; Advisory / Consultancy: Merrimack; Advisory / Consultancy: Merus; Advisory / Consultancy: Molecular Partners, Novartis, Peptomyc, Pfizer, Pharmacyclics, ProteoDesign SL, Rafael Pharmaceuticals, F. Hoffmann-La Roche Ltd, Sanofi, SeaGen, Seattle Genetics, Servier, Symphogen, Taiho, VCN Biosciences, Biocartis, Foundation Medicine, HalioDX SAS. E. Felip: Advisory / Consultancy: AbbVie, AstraZeneca, Blue Print Medicines, Boehringer Ingelheim, BMS, Celgene, Eli Lilly, Guardant Health, Merck KGaA, Merck Sharp & Dohme, Novartis, Pfizer, Roche, Takeda, Janssen; Speaker Bureau / Expert testimony: AbbVie, AstraZeneca, Boehringer Ingelheim, BMS, Eli Lilly, Merck KGaA, Merck sharp & dohme, Novartis, Pfizer, Roche, Takeda.; Research grant / Funding (self): Fundación Merck Salud Grant for Oncology Innovation. R. Dienstmann: Advisory / Consultancy: Roche ; Speaker Bureau / Expert testimony: Roche, Symphogen, Ipsen, Amgen, Sanofi, MSD, Servier; Research grant / Funding (self): Merck. All other authors have declared no conflicts of interest.