Unplanned hospitalizations in patients with locoregionally advanced head and neck cancer treated with (chemo)radiotherap
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RESEARCH
Unplanned hospitalizations in patients with locoregionally advanced head and neck cancer treated with (chemo)radiotherapy with and without prophylactic percutaneous endoscopic gastrostomy Beat Bojaxhiu1,2,5, Binaya K. Shrestha1†, Pascal Luterbacher1†, Olgun Elicin1, Mohamed Shelan1, Andrew J. S. Macpherson3, Benjamin Heimgartner3, Roland Giger4, Daniel M. Aebersold1 and Kathrin Zaugg1,5*
Abstract Background: Current studies about percutaneous endoscopic gastrostomy (PEG) tube placement report equivalent patient outcomes with prophylactic PEG tubes (pPEGs) versus common nutritional support. Unreported was if omitting a pPEG is associated with an increased risk of complications leading to a treatment-related unplanned hospitalization (TRUH). Methods: TRUHs were retrospectively analyzed in patients with advanced head and neck squamous cell carcinoma (n = 310) undergoing (chemo)radiotherapy with (pPEG) or without PEG (nPEG). Results: In 88 patients (28%), TRUH was reported. One of the leading causes of TRUH in nPEG patients was inadequate oral intake (n = 16, 13%), and in pPEG patients, complications after PEG tube insertion (n = 12, 10%). Risk factors for TRUH were poor performance status, tobacco use, and surgical procedures. Conclusions: Omitting pPEG tube placement without increasing the risk of an unplanned hospitalization due to dysphagia, dehydration or malnutrition, is an option in patients being carefully monitored. Patients aged > 60 years with hypopharyngeal carcinoma, tobacco consumption, and poor performance status appear at risk of PEG tube-related complications leading to an unplanned hospitalization. Keywords: Head and neck cancer, Percutaneous endoscopic gastrostomy, Morbidity, PEG, Radiotherapy Background Curative intended radiotherapy (RT) with or without concomitant chemotherapy of patients with locoregionally advanced (Union for International Cancer Control *Correspondence: [email protected] † Binaya K. Shrestha and Pascal Luterbacher have contributed equally to this work 1 Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland Full list of author information is available at the end of the article
[UICC] 7th edition: stage III–IVB) head and neck squamous cell carcinoma (HNSCC) may lead to malnutrition [1, 2], among other significant toxicities. An already existing dysphagia or odynophagia caused by the tumor can be aggravated by therapy-related inflammation, mucositis, and edema along the mucosal linings of the upper aero-digestive tract, as well as in the muscles of mastication and swallowing [3–5]. If this leads to grade 3 dysphagia according to Common Terminology Criteria for Adverse Events (CTCAE version 5.0) [6], feeding
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