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Percutaneous feeding tubes in patients with head and neck cancer: rethinking prophylactic placement for patients undergoing chemoradiation
American Journal of Otolaryngology, 07/10/09
Lawson JD et al. - In a study to examine the toxicities associated with feeding tube placement and predictors for duration of tube dependence, it was shown that feeding tubes are required for >2 mos after combined modality treatment of head and neck cancer (HNC). They are generally well tolerated, but toxicities are not trivial: >10% require replacement and >8% of pts develop infection at the insertion site.
Methods- Records were reviewed for pts receiving definitive radiotherapy between 6/1/2003 and 6/1/2006.
- Records of the subset of pts with feeding tube placement before initiation of therapy were reviewed for toxicities as well as length of time of tube dependence.
- There were 102 eligible pts.
- Radiotherapy was delivered with concomitant chemotherapy in all.
- Median time with feeding tube in place for all pts was 4.4 mos.
- For 82 pts with eventual tube removal, median time of tube dependence was 3.8 mos.
- Risk factors for prolonged tube dependence are analyzed; on multivariate analysis, pt age, T stage, and nodal status remained significant.
- Most common complication was tube replacement, with 11.8% of all tubes requiring replacement.
- Infection and pain occurred in 8.8% and 5.9% of pts, respectively.
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