Vangelov Belinda, Smee Robert I
Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, The Prince of Wales Hospital and Community Health Services, Randwick, NSW, Australia.
Department of Nutrition and Dietetics, The Prince of Wales Hospital, Randwick, NSW, Australia.
Eur Arch Otorhinolaryngol. 2017 Oct;274(10):3741-3749. doi: 10.1007/s00405-017-4681-x. Epub 2017 Jul 26.
Enteral feeding is often required for nutrition support in head and neck cancer patients when oral intake is inadequate. When to initiate the insertion of a feeding tube continues to be a debated issue in our institution. We investigated the use of reactive feeding tubes (RFTs) in patients with advanced stage oropharynx cancer (OPC). Data were retrospectively collected on 131 patients who had radiotherapy (RT) ± chemotherapy from 2005 to 2015. Predictors for RFT insertion were investigated. Weight loss during RT was compared between those with RFT versus prophylactic tubes (PFTs) versus no tube, and survival outcomes evaluated. RFTs were more likely to be needed in patients who had bilateral neck node irradiation (p = 0.001) and concurrent chemoradiotherapy (CRT) (p = 0.038). Patients with RFTs had significantly higher mean percentage weight loss during RT (9.5 ± 3.4%) (p < 0.001) when compared to those with a PFT (5.2 ± 4.7%) and those with no tube (5.4 ± 3.1%). No difference was seen in 5-year survival rates in patients who did not have a feeding tube to those who required a RFT. RFT use is frequent in OPC, although difficult to predict. CRT and bilateral neck node irradiation were found to be associated with the need for the insertion of a feeding tube during RT. These patients also experience significantly higher weight loss, therefore, prophylactic tubes may need to be considered more often in this population.
当口腔摄入量不足时，头颈部癌症患者通常需要肠内营养支持。在我们机构中，何时开始插入饲管仍是一个有争议的问题。我们研究了晚期口咽癌（OPC）患者中反应性饲管（RFT）的使用情况。回顾性收集了2005年至2015年期间接受放疗（RT）±化疗的131例患者的数据。研究了RFT插入的预测因素。比较了RFT组、预防性饲管（PFT）组和无饲管组患者在放疗期间的体重减轻情况，并评估了生存结果。接受双侧颈部淋巴结照射（p = 0.001）和同步放化疗（CRT）（p = 0.038）的患者更有可能需要RFT。与PFT组（5.2±4.7%）和无饲管组（5.4±3.1%）相比，RFT组患者在放疗期间的平均体重减轻百分比显著更高（9.5±3.4%）（p < 0.001）。未插饲管的患者与需要RFT的患者的5年生存率无差异。尽管难以预测，但RFT在OPC患者中使用频繁。发现CRT和双侧颈部淋巴结照射与放疗期间插入饲管的需求有关。这些患者的体重减轻也明显更高，因此，在这一人群中可能需要更频繁地考虑预防性饲管。
