Department of Nutrition and Dietetics, St. James's Institute of Oncology, Leeds, UK.
Oral Oncol. 2012 May;48(5):434-40. doi: 10.1016/j.oraloncology.2011.11.022. Epub 2011 Dec 29.
To determine the outcomes of patients managed with different routes of enteral feeding during chemoradiotherapy for oropharynx cancer. The hospital and dietetic records of consecutive patients with oropharynx squamous cell carcinoma treated between January 2007 and June 2009 with concurrent chemoradiotherapy were reviewed retrospectively. One hundred and four patients were analysed. Seventy-one received a prophylactic gastrostomy, 21 were managed with a strategy of NG tube as required and 12 received a therapeutic gastrostomy. Patients with a prophylactic gastrostomy commenced enteral feeding a median of 24 days after commencing radiotherapy, compared with a median of 41 days (p<0.001) for the NG as required group. Comparing prophylactic gastrostomy, NG as required and therapeutic gastrostomy, median number of unplanned inpatient days were 6, 14 and 7, respectively (p<0.01 for prophylactic gastrostomy vs. NG as required). Mean percentage weight loss at the end of treatment (6.1% vs. 7.1% vs. 5.2%, respectively) and at 6 months post-radiotherapy (11.7%, 14.3% and 8.9%) were similar in all groups (p=0.23). There was no significant difference in type of diet post-radiotherapy between prophylactic gastrostomy and NG as required groups (p=0.22). Median duration of enteral feeding was 181, 64 and 644 days, respectively (p<0.01 for prophylactic gastrostomy vs. NG as required). Use of a prophylactic gastrostomy (p<0.01) and higher T stage (p<0.01) were associated with increased duration of enteral feeding on a multivariate analysis. These data reinforce concerns regarding the detrimental impact of prophylactic gastrostomy placement upon long-term enteral feed dependence.
为了确定接受放化疗治疗的口咽鳞癌患者经不同肠内营养途径管理的结果。回顾性分析了 2007 年 1 月至 2009 年 6 月期间接受同期放化疗治疗的连续 104 例口咽鳞癌患者的医院和饮食记录。71 例患者接受预防性胃造口术，21 例患者按需接受经鼻胃管（NG）喂养策略，12 例患者接受治疗性胃造口术。与 NG 按需喂养组相比，预防性胃造口组开始肠内喂养的中位数时间为放疗后 24 天，而 NG 按需喂养组为 41 天（p<0.001）。与预防性胃造口术、NG 按需喂养和治疗性胃造口术相比，计划外住院天数中位数分别为 6、14 和 7 天（预防性胃造口术与 NG 按需喂养相比，p<0.01）。治疗结束时（分别为 6.1%、7.1%和 5.2%）和放疗后 6 个月（分别为 11.7%、14.3%和 8.9%）体重百分比丢失的平均值在所有组之间相似（p=0.23）。预防性胃造口术与 NG 按需喂养组放疗后饮食类型无显著差异（p=0.22）。肠内喂养的中位时间分别为 181、64 和 644 天（预防性胃造口术与 NG 按需喂养相比，p<0.01）。多变量分析显示，预防性胃造口术（p<0.01）和较高的 T 分期（p<0.01）与肠内喂养时间延长相关。这些数据强化了对预防性胃造口术放置对长期肠内喂养依赖的不利影响的担忧。
