Predictive Factors for Prophylactic Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement and Use in Head and Neck Patients Following Intensity-Modulated Radiation Therapy (IMRT) Treatment: Concordance, Discrepancies, and the Role of Gabapentin

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• 作者：Wuyang Yang ; Todd R. McNutt ; Sara A. Dudley ; Rachit Kumar ; Heather M. Starmer…
• 关键词：Percutaneous endoscopic gastrostomy ; Head and neck cancer ; Radiation therapy ; Intensity ; modulated radiation therapy ; Predictive factor ; Deglutition
• 刊名：Dysphagia
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：31
• 期：2
• 页码：206-213
• 全文大小：453 KB
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• 作者单位：Wuyang Yang (1)
  Todd R. McNutt (1)
  Sara A. Dudley (1)
  Rachit Kumar (1)
  Heather M. Starmer (2)
  Christine G. Gourin (2)
  Joseph A. Moore (1)
  Kimberly Evans (1)
  Mysha Allen (1)
  Nishant Agrawal (2) (3)
  Jeremy D. Richmon (2) (3)
  Christine H. Chung (3)
  Harry Quon (1) (2) (3)
  
  1. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 North Broadway, Suite 1440, Baltimore, MD, 21231, USA
  2. Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
  3. Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Otorhinolaryngology
  Imaging and Radiology
  Gastroenterology
  Hepatology
  
• 出版者：Springer New York
• ISSN：1432-0460

文摘

The prophylactic placement of a percutaneous endoscopic gastrostomy (PEG) tube in the head and neck cancer (HNC) patient is controversial. We sought to identify factors associated with prophylactic PEG placement and actual PEG use. Since 2010, data regarding PEG placement and use were prospectively recorded in a departmental database from January 2010 to December 2012. HNC patients treated with intensity-modulated radiation therapy (IMRT) were retrospectively evaluated from 2010 to 2012. Variables potentially associated with patient post-radiation dysphagia from previous literature, and our experience was evaluated. We performed multivariate logistic regression on these variables with PEG placement and PEG use, respectively, to compare the difference of association between the two arms. We identified 192 HNC patients treated with IMRT. Prophylactic PEG placement occurred in 121 (63.0 %) patients, with PEG use in 97 (80.2 %) patients. PEG placement was associated with male gender (p < .01), N stage ≥ N2 (p < .05), pretreatment swallowing difficulties (p < .01), concurrent chemotherapy (p < .01), pretreatment KPS ≥80 (p = .01), and previous surgery (p = .02). Concurrent chemotherapy (p = .03) was positively associated with the use of PEG feeding by the patient, whereas pretreatment KPS ≥80 (p = .03) and prophylactic gabapentin use (p < .01) were negatively associated with PEG use. The analysis suggests there were discrepancies between prophylactic PEG tube placement and actual use. Favorable pretreatment KPS, no pretreatment dysphagia, no concurrent chemotherapy, and the use of gabapentin were significantly associated with reduced PEG use. This analysis may help refine the indications for prophylactic PEG placement.