Timing of percutaneous endoscopic gastrostomy (PEG) tube placement as supportive care in HNSCC patients (Pts) receiving concurrent chemoradiotherapy (CRT).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17571-e17571
Author(s):  
Oleksandra Lupak ◽  
Michael Bazydlo ◽  
Farzan Siddiqui ◽  
Steven Chang ◽  
Bryan Coniglio ◽  
...  
Keyword(s):  
Locally Advanced ◽  
Standard Of Care ◽  
Tube Placement ◽  
Curative Intent ◽  
Oral Hydration ◽  
Endoscopic Gastrostomy ◽  
Treatment Interruptions ◽  
Standard Of Care Treatment ◽  
Ed Visits ◽  
Peg Tube

e17571 Background: Concurrent CRT with curative intent is the standard of care treatment for Pts with locally advanced or local recurrent head and neck squamous cell carcinoma (HNSCC). The CRT is associated with significant toxicities including nausea/vomiting, dysphagia and/or odynophagia, which prevent Pts from tolerating oral hydration and nutrition intakes. Treatment frequently leads to weight loss, renal injury and unexpected emergent care or hospitalizations along with therapy interruptions. This study is to determine the timing of PEG tube placement and its impact on the safety and tolerability from HNSCC patients receiving CRT. Methods: We retrospectively reviewed 413 electronic medical records (EMR), of which 335 of HNSCC Pts who had complete EMR during CRT period were included in this study. 127 of these 335 Pts (38%) required no PEG tube placement, 208 (62%) required PEG placement. The timing of PEG placement has been observed as two groups: 1) 109 Pts had PEG tube placement before initiation of CRT (Prophylactic Group PG); 2) 89 Pts had PEG tube during CRT period in reaction to a serious toxicity event (Reactive Group_RG). Logistic regressions were used to estimate the effect of PEG timing on Emergency Department (ED) visits, hospitalization, and experiencing treatment interruptions. Results: Our study showed that patients in PG demonstrated 43% less likely on their visiting ED or 42% less likely for hospitalization than Pts of RG with an odds ratio (OR) at 0.396 (95% CI: 0.165~0.952, p = 0.038) for PG over RG from toxicity-related therapy interruptions. Pts in PG also showed an OR at 0.40 from improving hypoalbuminemia over RG Pts (95% CI: 0.16~0.64, p = 0.001) which associated with 23% of chance of maintaining pre-CRT body mass index (BMI) for Pts in PG over those in RG. Conclusions: We observed the prophylactic PEG tube placement prevented unexpected ER visits and hospitalizations through reducing the risk of malnutrition and dehydration, which improved Pts in PG through the CRT with less therapy interruptions and preserved BMI, especially for those Pts of older age, pre-therapy dysphagia, hypoalbuminemia and receiving cisplatin in CRT.

Use of prophylactic percutaneous endoscopic gastrostomy (pPEG) tube in head and neck cancer (HNC) patients and correlation of weight loss with treatment interruptions.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17509-e17509
Author(s):  
Deepali Pandey ◽  
Lisa Gibbs ◽  
Kamal Kant Sahu ◽  
Ahmad Daniyal Siddiqui
Keyword(s):  
Weight Loss ◽  
Statistical Tests ◽  
Locally Advanced ◽  
T Test ◽  
Tube Placement ◽  
Optimal Timing ◽  
Average Weight ◽  
Average Percentage ◽  
Treatment Interruptions ◽  
Peg Tube

e17509 Background: HNC patients are at risk for weight loss which can cause treatment interruptions, and poorer outcomes. There is no consensus on optimal timing of PEG tube placement in HNC patients undergoing concurrent ChemoTherapy (CT) and RadioTherapy (RT). The aim of this study is to determine if pPEG tube would decrease weight loss (WL) in HNC patients. We also analyzed correlation between WL and CT interruptions (CTI), RT interruptions (RTI), and intravenous fluid requirements (IVFr). Methods: This is a prospective study. A total of 16 HNC patients undergoing concurrent CT, RT were included. Before treatment initiation, a PEG tube placement was recommended as a mode of nutrition. 13 patients chose to get pPEG tube and 3 refused. We collected data on weight at 0 and 2 months, CTI, RTI, and IVFr. CTI included missed as well as reduced chemotherapy doses. RTI included missed radiations. Statistical tests used - t-test, Levene’s test for equality of variances and point biserial correlation. Results: Median age - 63 years; Gender: 14 Male/2 Female; Tumor location - Oral cavity - 31.3%; Oropharynx - 43.7%; Larynx - 25%; Nasopharynx and Hypopharynx- 0%. Stages were - II (6.2%), III (37.5%) and IV (56.3%). 2 patients were non-smoker and 4 were Human Papilloma Virus positive. Mean WL(lb) in pPEG (n = 11) vs non-PEG (n = 3) group was 10.3 vs 20.3 (p = 0.045, one-tailed t-test). Average percentage of WL: PEG vs non-PEG - 5.8 vs 8.2; RTI vs not - 8.9 vs 5.3; CTI vs not - 6.9 vs 5.8; IVFr vs not - 6.8 vs 4.5 ( > 7.5% WL over 3 months is significant (ADA/ASPEN)). CTI, RTI and IVFr were positively correlated to WL (correlation coefficient: 0.16; 0.32; 0.17 respectively). CTI and RTI in pPEG group were 23.1% and 38.5% respectively. CTI and RTI in non-PEG group were 33.3% and 66.7% respectively. 2 patients in pPEG group had average weight gain of 2.75 lb. Only 3 patients had PEG tube related complications - infections and clogging. Conclusions: pPEG tube decreases weight loss in locally advanced HNC patients. Patients with higher weight loss had more chemoradiation interruptions and IVFr. HNC patients undergoing concurrent CT, RT should be encouraged to maintain weight and get a PEG tube.

Factors associated with hospitalization in patients (pts) with locally advanced squamous cell carcinoma of the head and neck (LA-HNSCC) treated with definitive chemoradiation (CRT).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18035-e18035
Author(s):  
Soo J Park ◽  
Mili Parikh ◽  
Joanne Harrington ◽  
Pia Heppner ◽  
Kelly McCarthy ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Radiation Treatment ◽  
Smoking Status ◽  
Medical Center ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Tube Placement ◽  
Smoking History ◽  
Factors Associated ◽  
Treatment Interruptions

e18035 Background: Definitive CRT is the standard of care for LA-HNSCC and associated with mucosal toxicity and treatment-related morbidity. Nutritional support via gastrostomy tube (G-tube) during CRT may reduce treatment-related complications. This study aims to identify factors associated with hospitalization in pts with LA-HNSCC treated with CRT. Methods: We conducted a medical record review of pts with LA-HNSCC treated with CRT between January 2010 and December 2019 at the VA San Diego Medical Center. Demographic and clinical factors were compared for pts based on hospitalization and G-tube placement. Logistic regression was used to identify associations with hospitalization and treatment interruptions. Results: Data on 100 pts (98% male) were analyzed. 21 pts were hospitalized, and 17 pts had radiation treatment (RT) interrupted. 72 pts had prophylactic G-tube (p-G-tube) placement, and 11 pts had reactive G-tube (r-G-tube) placement. Hospitalized and non-hospitalized pts did not differ by ethnicity, alcohol use status, or chemotherapy type. Hospitalized vs non-hospitalized pts were older (mean 67.6 vs 63.8, P = 0.043), more likely to lose more weight during CRT (-14.90% vs -10.60%, P = 0.009), less likely to complete CRT (71.4% vs 92.4%, P = 0.009), and more likely to have chemotherapy (42.9% vs 3.8%, P < 0.001) and RT interruptions (71.4% vs 2.5%, P < 0.001). Logistic regression used to predict hospitalization and RT interruption were significant (X2= 35.24, P = 0.002 and X2= 31.97, P = 0.007, respectively). The effect testing p-G-tube vs r-G-tube placement was the only factor significantly associated with lower likelihood of hospitalization during CRT (Wald = 4.61, P = 0.032) and RT interruption (Wald = 6.02, P = 0.014). Pts with r-G-tube placement lost more weight during CRT (-16.79% vs -10.82% with p-G-tube, -10.97% with no G-tube, P = 0.022), had higher hospitalization rates during CRT (72.7% vs 18.1% with p-G-tube, 0% with no G-tube, P < 0.001), had increased likelihood of RT interruption (63.6% vs 13.9% with p-G-tube, 0% with no G-tube, P < 0.001), and were more likely to receive weekly cisplatin (45.5% vs 9.7% with p-G-tube, 41.2% with no G-tube, P = 0.018). Prophylactic G-tube placement was associated with current smoking status (43.1% vs 9.1% with r-G-tube, 41.2% with no G-tube, P = 0.009), bolus cisplatin (52.8% vs 36.4% with r-G-tube, 35.3% with no G-tube, P = 0.018), and cetuximab (27.8% vs 9.1% with r-G-tube, 11.8% with no G-tube, P = 0.018). Conclusions: Prophylactic G-tube placement should be considered for pts with LA-HNSCC treated with CRT regardless of smoking history and chemotherapy choice to decrease treatment-related hospitalizations and RT interruptions. This may be more important for indigent pts since prior research has shown treatment interruptions occur at higher rates in this at-risk population.

scholarly journals Irreversible Electroporation (IRE) in Locally Advanced Pancreatic Cancer: A Review of Current Clinical Outcomes, Mechanism of Action and Opportunities for Synergistic Therapy

2021 ◽  
Vol 10 (8) ◽  
pp. 1609
Author(s):  
Zainab L. Rai ◽  
Roger Feakins ◽  
Laura J. Pallett ◽  
Derek Manas ◽  
Brian R. Davidson
Keyword(s):  
Pancreatic Cancer ◽  
Mechanism Of Action ◽  
Locally Advanced ◽  
Irreversible Electroporation ◽  
Advanced Pancreatic Cancer ◽  
Standard Of Care ◽  
Locally Advanced Pancreatic Cancer ◽  
Animal Data ◽  
Standard Of Care Treatment ◽  
Apoptosis And Necrosis

Locally advanced pancreatic cancer (LAPC) accounts for 30% of patients with pancreatic cancer. Irreversible electroporation (IRE) is a novel cancer treatment that may improve survival and quality of life in LAPC. This narrative review will provide a perspective on the clinical experience of pancreas IRE therapy, explore the evidence for the mode of action, assess treatment complications, and propose strategies for augmenting IRE response. A systematic search was performed using PubMed regarding the clinical use and safety profile of IRE on pancreatic cancer, post-IRE sequential histological changes, associated immune response, and synergistic therapies. Animal data demonstrate that IRE induces both apoptosis and necrosis followed by fibrosis. Major complications may result from IRE; procedure related mortality is up to 2%, with an average morbidity as high as 36%. Nevertheless, prospective and retrospective studies suggest that IRE treatment may increase median overall survival of LAPC to as much as 30 months and provide preliminary data justifying the well-designed trials currently underway, comparing IRE to the standard of care treatment. The mechanism of action of IRE remains unknown, and there is a lack of data on treatment variables and efficiency in humans. There is emerging data suggesting that IRE can be augmented with synergistic therapies such as immunotherapy.

Early report on percutaneous endoscopic gastrostomy at Owerri, Nigeria

2021 ◽  
Vol 0 ◽  
pp. 1-4
Author(s):  
Christopher Nonso Ekwunife ◽  
Kelechi E. Okonta ◽  
Stephen E. Enendu
Keyword(s):  
Percutaneous Endoscopic Gastrostomy ◽  
Early Report ◽  
Cross Sectional Study ◽  
Tube Placement ◽  
Safe Procedure ◽  
Cross Sectional ◽  
Endoscopic Gastrostomy ◽  
Neurologic Disorders ◽  
Superficial Skin ◽  
Peg Tube

Objectives: Percutaneous endoscopic gastrostomy (PEG) is a well-established endoscopic procedure that is used predominantly to create enteral access for feeding. Its use has not been widespread in Nigeria despite its efficacy. This study is done to review the early experiences in the use of PEG in Federal Medical Centre, Owerri and Carez Clinic, Owerri. Material and Methods: This is a 4-year retrospective cross-sectional study of patients who had PEG from January 2015 to December 2018. The indications, complications, and outcomes of the procedure were analyzed. Results: A total of 13 patients had pull-type gastrostomy during this period. Six (46.1%) patients had the procedure on account of neurologic disorders, 4 (30.8%) patients had esophageal tumors, while 3 (23.1%) patients had esophageal motility disorders. The overall success rate for PEG tube placement was 100%. The most common complication was superficial skin infection 30.8% (4/13). No mortality was attributable to the procedure. Conclusion: PEG is still not commonly done in our setting, but it is a relatively safe procedure. Physicians should be encouraged to offer it to our teeming patients with neurologic disorders who may benefit from it.

Advances in systemic therapy for non-small cell lung cancer

BMJ ◽  
2021 ◽  
pp. n2363
Author(s):  
Meagan Miller ◽  
Nasser Hanna
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Small Cell ◽  
Small Cell Lung ◽  
Incurable Disease ◽  
Innovative Therapies ◽  
Standard Of Care Treatment

ABSTRACT Lung cancer remains a leading cause of cancer related mortality worldwide. Despite numerous advances in treatments over the past decade, non-small cell lung cancer (NSCLC) remains an incurable disease for most patients. The optimal treatment for all patients with locally advanced, but surgically resectable, NSCLC contains at least chemoradiation. Trimodality treatment with surgical resection has been a subject of debate for decades. For patients with unresectable or inoperable locally advanced disease, the incorporation of immunotherapy consolidation after chemoradiation has defined a new standard of care. For decades, the standard of care treatment for advanced stage NSCLC included only cytotoxic chemotherapy. However, with the introduction of targeted therapies and immunotherapy, the landscape of treatment has rapidly evolved. This review discusses the integration of these innovative therapies in the management of patients with newly diagnosed NSCLC.

Safety and efficacy of percutaneous endoscopic gastrostomy tube placement in patients with malignant peritoneal carcinomatosis induced bowel obstruction.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14012-e14012
Author(s):  
Pankaj G Vashi ◽  
Donald Peter Braun ◽  
Brenten Popiel ◽  
Digant Gupta
Keyword(s):  
Peritoneal Carcinomatosis ◽  
Bowel Obstruction ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Insertion Site ◽  
Tube Placement ◽  
Percutaneous Endoscopic Gastrostomy Tube ◽  
Safety And Efficacy ◽  
Symptom Resolution ◽  
Endoscopic Gastrostomy ◽  
Peg Tube

e14012 Background: Percutaneous Endoscopic Gastrostomy (PEG) tube placement in advanced peritoneal carcinomatosis with bowel obstruction is a feasible palliative procedure to help patients with obstructive symptoms. We describe the safety and efficacy of using PEG tube for decompression in patients with large peritoneal masses. Methods: A consecutive case series of 62 patients (Apr-08 to Jun-11) with advanced abdominal carcinomatosis induced bowel obstruction. All patients were extensively treated for their cancer. None of them were surgical candidates due to extensive peritoneal involvement. All patients had symptoms of nausea, vomiting and pain at the time of PEG tube placement. All patients had a 28F (Bard) PEG tube placed for drainage. The primary outcomes of interest were complications and symptom resolution due to PEG tube placement. Frequency of nausea, vomiting and severity of pain was recorded daily in patient charts. Results: 16 were males and 46 females. The mean age was 50.5 years. Most common cancers were ovary, pancreas, colon and stomach. Of 62 patients, 57 patients had expired at the time of this analysis. Of those 57 expired, 49 had PEG tube at the time of death, while 8 had complete resolution of symptoms with PEG tube removed before death. The 5 out of 62 patients who are alive still have the PEG tube for drainage (average 70.4 days). The average duration of PEG tube placement for all patients combined was 70.9 days (range 6-312 days). Relief of nausea, vomiting and pain was observed in 53 (85.5%), 55 (88.7%) and 35 (56.5%) patients respectively. Of a total of 43 patients who had PEG tube placed for >= 30 days, 24 (56%) could continue with their chemotherapy cycles because of symptom resolution. Non life threatening complications of PEG tube placement were observed in 9 (14.5%) patients. 3 had infection at the insertion site, 2 had bleeding and 3 had leaking at the PEG tube site while 1 had aspiration. 6 (9.7%) patients required replacement of the PEG tube due to occlusion. Conclusions: Placement of PEG tube in presence of advanced peritoneal carcinomatosis is safe and effective in relieving obstructive symptoms as well as extending the period of active cancer therapy.

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