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.

Can induction chemotherapy improve dysphagia in locally advanced esophageal/GEJ cancer?

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 148-148
Author(s):  
Elizabeth Won ◽  
David H. Ilson ◽  
Jessica Herrera ◽  
Yelena Yuriy Janjigian ◽  
Geoffrey Yuyat Ku ◽  
...  
Keyword(s):  
Weight Loss ◽  
Esophageal Cancer ◽  
Nutritional Status ◽  
Induction Chemotherapy ◽  
Locally Advanced ◽  
Concurrent Chemoradiation ◽  
Tube Placement ◽  
Average Weight ◽  
Feeding Tubes ◽  
Presenting Symptoms

148 Background: Dysphagia is one of the most common presenting symptoms in esophageal cancer (EC) and can lead to significant nutritional decline, which is associated with increased toxicity and poor outcomes. Invasive feeding tubes or endoscopic stents are frequently used to improve nutrition in this setting. We evaluated the role of induction chemotherapy prior to concurrent chemoradiation as presurgical treatment in improving dysphagia. Methods: Retrospective analysis of 4 prospective studies conducted at MSKCC with induction chemotherapy followed by concurrent chemoradiation and surgery in locally advanced esophageal/GEJ cancer. Regimens included cisplatin/paclitaxel, cisplatin/irinotecan, and cisplatin/irinotecan/bevacizumab. Dysphagia was graded prospectively using a validated dysphagia scale. Response of dysphagia and nutritional status to induction chemotherapy was evaluated. Results: Of 161 patients (pts) undergoing induction chemotherapy, [median age 59(21-76), KPS 90 (70-100), 77% adenocarcinoma], 121 (76%) had dysphagia, with 59(37%) having grade 2 dysphagia or higher (20% Stage II, 80% Stage III). 6(4%) required EGD dilatation/stent and none required feeding tube placement prior to treatment. 22% patients had>10% body weight loss prior to treatment and average weight loss in all pts was 4.3kg. After induction chemotherapy, 104 (64%) had improvement in dysphagia. This was associated with a weight gain in 42% of pts. Only 7(4%) had worsening dysphagia after induction chemotherapy: 4/7 required feeding tubes (2% of all pts), 2/7 underwent endoscopic dilatation or stent (1% of all pts). 6/7 of these pts with worsening dysphagia had poor short term outcomes after induction treatment: 2/7 progressive disease, 3/7 unresectable at surgery, 1/7 post-operative death. Conclusions: Induction chemotherapy prior to concurrent chemoradiation for locally advanced esophageal cancer can effectively improve swallowing and nutritional status, while mitigating need for feeding tubes or stents in patients with significant dysphagia. Post-induction dysphagia may be prognostic and merits further investigation.

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.

Exploration of the Effects of PEG Tube Placement on Weight Loss in Patients with ALS

2017 ◽  
Vol 117 (9) ◽  
pp. A24
Author(s):  
R. Jardon ◽  
J. Paseka ◽  
G. Woscyna ◽  
C. Hanson
Keyword(s):  
Weight Loss ◽  
Tube Placement ◽  
Peg Tube

scholarly journals Continued Weight Loss and Sarcopenia Predict Poor Outcomes in Locally Advanced Pancreatic Cancer Treated with Chemoradiation

Cancers ◽  
2019 ◽  
Vol 11 (5) ◽  
pp. 709 ◽  
Author(s):  
Patrick Naumann ◽  
Jonathan Eberlein ◽  
Benjamin Farnia ◽  
Thilo Hackert ◽  
Jürgen Debus ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Pancreatic Cancer ◽  
Weight Loss ◽  
Muscle Mass ◽  
Muscle Wasting ◽  
Statistical Tests ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Skeletal Muscle Index ◽  
Poor Outcomes

Background: Surgical resection offers the best chance of survival in patients with pancreatic cancer, but those with locally advanced disease (LAPC) are usually not surgical candidates. This cohort often receives either neoadjuvant chemotherapy or chemoradiation (CRT), but unintended weight loss coupled with muscle wasting (sarcopenia) can often be observed. Here, we report on the predictive value of changes in weight and muscle mass in 147 consecutive patients with LAPC treated with neoadjuvant CRT. Methods: Clinicopathologic data were obtained via a retrospective chart review. The abdominal skeletal muscle area (SMA) at the third lumbar vertebral body was determined via computer tomographic (CT) scans as a surrogate for the muscle mass and skeletal muscle index (SMI) calculated. Uni- and multi-variable statistical tests were performed to assess for impact on survival. Results: Weight loss (14.5 vs. 20.3 months; p = 0.04) and loss of muscle mass (15.1 vs. 22.2 months; p = 0.007) were associated with poor outcomes. The highest survival was observed in patients who had neither cachectic weight loss nor sarcopenia (27 months), with improved survival seen in those who ultimately received a resection (23 vs. 10 months; p < 0.001). Cox regression revealed that either continued weight loss or continued muscle wasting (SMA reduction) was predictive of poor outcomes, whereas a sarcopenic SMI was not. Conclusions: Loss of weight and lean muscle in patients with LAPC is prognostic when persistent. Therefore, both should be assessed longitudinally and considered before surgery.

scholarly journals Proton Therapy for Locally Advanced Oropharyngeal Cancer: Initial Clinical Experience at the University of Washington

2019 ◽  
Vol 6 (3) ◽  
pp. 1-12
Author(s):  
Saif Aljabab ◽  
Andrew Liu ◽  
Tony Wong ◽  
Jay J. Liao ◽  
George E. Laramore ◽  
...  
Keyword(s):  
Clinical Experience ◽  
Proton Therapy ◽  
Cell Cancer ◽  
Locally Advanced ◽  
Progression Free Survival ◽  
Late Toxicity ◽  
Complete Response ◽  
Tube Placement ◽  
Treatment Interruptions ◽  
Early Results

Abstract Purpose: Proton therapy can potentially improve the therapeutic ratio over conventional radiation therapy for oropharyngeal squamous cell cancer (OPSCC) by decreasing acute and late toxicity. We report our early clinical experience with intensity-modulated proton therapy (IMPT). Materials and Methods: We retrospectively reviewed patients with OPSCC treated with IMPT at our center. Endpoints include local regional control (LRC), progression-free survival (PFS), overall survival (OS), tumor response, and toxicity outcomes. Toxicity was graded as per the Common Terminology Criteria for Adverse Events v4.03. Descriptive statistics and Kaplan-Meier method were used. Results: We treated 46 patients from March 2015 to August 2017. Median age was 58 years, 93.5% were male, 67% were nonsmokers, 98% had stage III-IVB disease per the 7th edition of the AJCC [American Joint Committee on Cancer] Cancer Staging Manual, and 89% were p16 positive. Twenty-eight patients received definitive IMPT to total dose of 70 to 74.4 Gy(RBE), and 18 patients received postoperative IMPT to 60 to 66 Gy(RBE) following transoral robotic surgery (TORS). Sixty-four percent of patients received concurrent systemic therapy. There were no treatment interruptions or observed acute grade 4 or 5 toxicities. Eighteen patients had percutaneous endoscopic gastrostomy (PEG) tube placement; the majority (14) were placed prophylactically. The most common grade 3 acute toxicities were dermatitis (76%) and mucositis (72%). The most common late toxicity was grade 2 xerostomia (30%). At a median follow-up time of 19.2 months (interquartile range [IQR], 11.2-28.4), primary complete response was 100% and nodal complete response was 92%. One patient required a salvage neck dissection owing to an incomplete response at 4 months. There were no recorded local regional or marginal recurrences, PFS was 93.5%, and OS was 95.7%. Conclusion: Our early results for IMPT in OPSCC are promising with no local regional or marginal recurrences and a favorable toxicity profile. Our data add to a body of evidence that supports the clinical use of IMPT. Randomized comparative trials are encouraged.

scholarly journals Percutaneous Endoscopic Gastrostomy in Children: Experience from Single Center of a Developing Country

2014 ◽  
Vol 34 (2) ◽  
pp. 125-131
Author(s):  
Mohit Kehar ◽  
Nishant Wadhwa ◽  
Satyam Upadhyay
Keyword(s):  
Percutaneous Endoscopic Gastrostomy ◽  
Effective Means ◽  
Insertion Site ◽  
Tube Placement ◽  
P Value ◽  
Average Weight ◽  
Average Height ◽  
Endoscopic Gastrostomy ◽  
Post Procedure ◽  
Peg Tube

Introduction: Nutrition is of paramount importance for adequate growth and development of a child. Various routes of providing enteral nutrition to a paediatric patient are by nasogastric, nasojejeunal and gastrostomy which can be placed surgically or endoscopically. The objectives of this study were to review cases with percutaneous endoscopic gastrostomy (PEG) procedure and patient characteristics, indications, complications and outcome of PEG tube insertion in children at our center.Materials and Methods: This was a prospective study carried out in Sir Ganga Ram Hospital in New Delhi, India for a period of two years from August 2010 to August 2012. It included patients in whom PEG tube were placed during the study period and have had at least one year of post procedure follow up. Demograhic details, duration of procedure, complications, initial weight and height and then at 3 month, 6 months and 12 months of PEG tube placement were also recorded. Data between groups was compared using ANOVA and within groups across follow-ups was done using paired t-test.Results: Fourty six PEG insertions were performed during the study period, 26 twenty six conversions to BRT or Mickey button and ten PEG removals. The main indications for PEG insertion were Cerebral palsy with feeding difficulty (47.8 %). Erythema at the PEG insertion site was the most common complication (21%). There was significant improvement in the weight and height in all age group of patients at 3, 6 and 12 months post procedure with a p value <0.5. The average weight gain after 3, 6 and 12 months was 1.3 kg, 2.8 kg and 4.2 kg and the average height gain after 3, 6 and 12 months was 1.6 cm, 2.5 cm and 4.13 cm respectively.Conclusions: PEG is effective means for optimizing the nutritional goals of patients who are nutritionally debilitated with minimal complications.  DOI: http://dx.doi.org/10.3126/jnps.v34i2.10960J Nepal Paediatr Soc 2014;34(2):125-131 

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 Long-Term Iron and Vitamin B12 Deficiency are Present After Bariatric Surgery, Despite the Widespread Use of Supplements.

2021 ◽  
Author(s):  
Mauro Lombardo ◽  
Arianna Franchi ◽  
Roberto Biolcati Rinaldi ◽  
Giancluca Rizzo ◽  
Monica D'Adamo ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Vitamin B12 ◽  
Vitamin B12 Deficiency ◽  
Excess Weight ◽  
Nutritional Deficiencies ◽  
Average Weight ◽  
Average Percentage ◽  
Nutritional Studies

Long-term nutritional studies in subjects undergoing bariatric surgery that have assessed weight regain and nutritional deficiencies are few. In this study, we report data 8 years after surgery on weight loss, use of dietary supplements and deficit of micronutrients in a cohort of patients from five centres in central and northern Italy. The study group consisted of 52 subjects (age: 38.1&plusmn;10.6 yrs, 42 females): 16 patients had Roux-en-Y gastric bypass (RYGB), 25 patients sleeve gastrectomy (LSG) and 11 subjects adjustable gastric banding (AGB). All three bariatric procedures led to sustained weight loss: average percentage excess weight loss, defined as weight loss divided by excess weight based on ideal body weight was 60.6%&plusmn;32.3. 80.7% of subjects (72.7%, AGB; 76%, SG; 93.7%, RYGB) reported at least one nutritional deficiency: iron (F 64.3% vs. M 30%), vitamin B12 (F 16.6% vs. M 10%), calcium (F 33.3% vs. M 0%) and vitamin D (F 38.1% vs. M 60%). Average weight loss was constant in RYGB and SG subjects from the third year after surgery. Long-term nutritional deficiencies were greater than the general population among men for iron and among women for vitamin B12.

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