Brown T E, Getliffe V, Banks M D, Hughes B G M, Lin C Y, Kenny L M, Bauer J D
Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.
Centre for Dietetics Research (C-DIET-R), School of Human Movement Studies, University of Queensland, Brisbane, QLD, Australia.
Eur J Clin Nutr. 2016 May;70(5):574-81. doi: 10.1038/ejcn.2015.230. Epub 2016 Feb 10.
BACKGROUND/OBJECTIVES: Evidence-based practice guidelines are available to assist in the decision making for nutrition interventions in patients with head and neck cancer. Re-assessment of guideline recommendations is important with changing demographics, new treatment regimens, advancing radiotherapy techniques, such as helical intensity-modulated radiotherapy, and the emergence of new literature. The aim of this study was to validate the updated high-risk category definition in our local hospital protocol for the swallowing and nutrition management of patients with head and neck cancer to determine the ongoing predictive ability for identifying proactive gastrostomy requirement in a new cohort.
SUBJECTS/METHODS: Patients attending a major tertiary hospital for head and neck cancer treatment from 2010 to 2011 were included (n=270). Data were collected on patient demographics (age and gender), clinical factors (tumour site, staging and treatment), nutrition outcome measures (weight, enteral feeding) and protocol adherence. Sensitivity and specificity were calculated and compared with the original validation study.
Proactive gastrostomy tubes were inserted in 86 patients. Overall protocol adherence was 93%. Sensitivity improved to 72% (increase of 18%) and specificity improved to 96% (increase of 3%) compared with the original validation study where patients received three-dimensional (3-D) conformal radiotherapy.
The results of this study confirm that the updated high-risk category in the protocol for the swallowing and nutrition management of patients with head and neck cancer remains valid to predict proactive gastrostomy in a mixed population receiving helical intensity-modulated radiotherapy and 3-D conformal radiotherapy. The protocol has an improved sensitivity and specificity and hence remains just as relevant for advanced techniques of radiation treatment delivery.
背景/目的：循证实践指南可协助对头颈部癌患者的营养干预进行决策。随着人口结构变化、新的治疗方案、先进放疗技术（如螺旋调强放疗）的发展以及新文献的出现，重新评估指南建议很重要。本研究的目的是验证我们当地医院方案中更新的高危类别定义，用于头颈部癌患者吞咽和营养管理，以确定在新队列中识别预防性胃造口术需求的持续预测能力。
受试者/方法：纳入2010年至2011年在一家大型三级医院接受头颈部癌治疗的患者（n = 270）。收集患者人口统计学数据（年龄和性别）、临床因素（肿瘤部位、分期和治疗）、营养结局指标（体重、肠内喂养）和方案依从性。计算敏感性和特异性，并与原始验证研究进行比较。
86例患者插入了预防性胃造口管。总体方案依从性为93%。与患者接受三维适形放疗的原始验证研究相比，敏感性提高到72%（增加18%），特异性提高到96%（增加3%）。
本研究结果证实，头颈部癌患者吞咽和营养管理方案中更新的高危类别在预测接受螺旋调强放疗和三维适形放疗的混合人群中的预防性胃造口术方面仍然有效。该方案具有更高的敏感性和特异性，因此对于先进的放射治疗技术仍然同样适用。
