Background. Oral intake of many patients with locally advanced head and neck cancer (LAHNC) decrease during chemoradiotherapy (CRT). Although prophylactic percutaneous endoscopic gastrostomy (PEG) is recommended, not a few patients complete CRT without using PEG tube. Patients and Methods. The subjects were patients with LAHNC who received CRT. We retrospectively investigated the incidence and duration of nutritional support during and after CRT, and predicting factors of nutritional support. For patients who required nutritional support, we also checked the day of initiation and the duration of nutritional support. Results. Of 53 patients, 29 patients (55%) required nutritional support during and/or after CRT. While no clear relation between requirement of nutritional support and variables including age, T stage, N stage, clinical stage and chemotherapy regimen, there could be some relationships between tumor primary sites and the requirement and duration of nutritional support. 17 (77%) of 22 patients with oropharynx cancer(OP) required nutritional support and prolonged for 4.4 months, and 11 (46%) of 24 patients with hypopharynx cancer(HP) required nutritional support and prolonged for 21.9 months. Conclusion. Nutritional support is indicated many HNC patients treated with CRT and primary sites may have some relation to its indication and duration. 1. Introduction Chemoradiotherapy (CRT) is one of the treatment choices for locally advanced head and neck squamous cell carcinoma (HNCSCC), not only for patients with unresectable disease, but also for those who desire organ preservation. However, the treatment course is often complicated by the development of painful mucositis, which causes difficulty in oral intake. Furthermore, in some patients, dysphagia occurring as a result of CRT causes life-threatening aspiration pneumonia during and/or after treatment [1, 2]. These obstacles to oral intake often result in treatment failure, prolongation of hospitalization, and treatment-related death [3]. Many physicians have begun to pay more attention to these adverse effects and to developing means to overcome these adverse effects and support the patients’ nutrition during and after CRT [4]. While placement of a percutaneous endoscopic gastrostomy (PEG) or gastric feeding tube (GFT) before CRT is recommended in Western countries, prophylactic placement of a GFT has generally not been accepted in Japan. In addition, some patients do not require nutritional support at all. It would be reasonable to carefully select patients in whom PEG or GFT should be
References
[1]
A. Eisbruch, T. Lyden, C. R. Bradford et al., “Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-and-neck cancer,” International Journal of Radiation Oncology Biology Physics, vol. 53, no. 1, pp. 23–28, 2002.
[2]
N. P. Nguyen, C. C. Moltz, C. Frank et al., “Dysphagia following chemoradiation for locally advanced head and neck cancer,” Annals of Oncology, vol. 15, no. 3, pp. 383–388, 2004.
[3]
N. P. Nguyen, C. C. Moltz, C. Frank et al., “Aspiration rate following chemoradiation for head and neck cancer: an underreported occurrence,” Radiotherapy and Oncology, vol. 80, no. 3, pp. 302–306, 2006.
[4]
E. J. Grobbelaar, S. Owen, A. D. Torrance, and J. A. Wilson, “Nutritional challenges in head and neck cancer,” Clinical Otolaryngology and Allied Sciences, vol. 29, no. 4, pp. 307–313, 2004.
[5]
J. J. Frowen and A. R. Perry, “Swallowing outcomes after radiotherapy for head and neck cancer: a systematic review,” Head and Neck, vol. 28, no. 10, pp. 932–944, 2006.
[6]
N. P. Nguyen, D. North, H. J. Smith et al., “Safety and effectiveness of prophylactic gastrostomy tubes for head and neck cancer patients undergoing chemoradiation,” Surgical Oncology, vol. 15, no. 4, pp. 199–203, 2006.
[7]
A. Raykher, L. Correa, L. Russo et al., “The role of pretreatment percutaneous endoscopic gastrostomy in facilitating therapy of head and neck cancer and optimizing the body mass index of the obese patient,” Journal of Parenteral and Enteral Nutrition, vol. 33, no. 4, pp. 404–410, 2009.
[8]
B. S. Bleier, M. S. Levine, R. Mick et al., “Dysphagia after chemoradiation: analysis by modified barium swallow,” Annals of Otology, Rhinology and Laryngology, vol. 116, no. 11, pp. 837–841, 2007.
[9]
L. A. Goguen, M. R. Posner, C. M. Norris et al., “Dysphagia after sequential chemoradiation therapy for advanced head and neck cancer,” Otolaryngology—Head and Neck Surgery, vol. 134, no. 6, pp. 916–922, 2006.
[10]
D. I. Rosenthal, J. S. Lewin, and A. Eisbruch, “Prevention and treatment of dysphagia and aspiration after chemoradiation for head and neck cancer,” Journal of Clinical Oncology, vol. 24, no. 17, pp. 2636–2643, 2006.
[11]
S. G. Shiley, C. A. Hargunani, J. M. Skoner, J. M. Holland, and M. K. Wax, “Swallowing function after chemoradiation for advanced stage oropharyngeal cancer,” Otolaryngology—Head and Neck Surgery, vol. 134, no. 3, pp. 455–459, 2006.
[12]
T. Kotz, R. Costello, Y. Li, and M. R. Posner, “Swallowing dysfunction after chemoradiation for advanced squamous cell carcinoma of the head and neck,” Head and Neck, vol. 26, no. 4, pp. 365–372, 2004.
[13]
E. J. Franzmann, D. S. Lundy, A. A. Abitbol, and W. J. Goodwin, “Complete hypopharyngeal obstruction by mucosal adhesions: a complication of intensive chemoradiation for advanced head and neck cancer,” Head and Neck, vol. 28, no. 8, pp. 663–670, 2006.
