Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital and Community Health Service, Randwick, New South Wales, Australia.
Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia.
Nutr Cancer. 2021;73(2):262-272. doi: 10.1080/01635581.2020.1750660. Epub 2020 Apr 11.
Critical weight loss (CWL) continues to be a major issue in head and neck cancer (HNC) and many patients require tube feeding. We investigated the use of reactive feeding tubes (RFTs), associated CWL, and the impact on cancer-specific survival (CSS). A single-institution, retrospective audit was conducted on 460 adult HNC patients who received radiotherapy ± chemotherapy between 2005 and 2017. CSS in patients with CWL and RFTs was compared to those with no tube. Prediction analysis for RFT insertion was also performed. CWL occurred in 53% of patients, and in 88% of those with a RFT ( < 0.001). In patients with CWL, those with a RFT had worse 5 and 10-year CSS compared to those with no tube (68% and 65% vs 83% and 80% respectively, = 0.040) in multivariate Cox regression analysis. Concurrent chemoradiotherapy combined with CWL was the strongest predictor for RFT insertion ( = 0.003). CWL, combined with having a RFT, impacts negatively on CSS. CWL may be one of the triggers for RFT insertion, however those with no tube have better CSS. This may be due to higher weight loss levels seen in those who have a RFT, and earlier insertion to prevent such losses seems indicated.
严重体重下降（CWL）仍然是头颈部癌症（HNC）的一个主要问题，许多患者需要进行管饲。我们研究了反应性喂养管（RFT）的使用、相关的 CWL 以及对癌症特异性生存（CSS）的影响。对 2005 年至 2017 年间接受放疗±化疗的 460 例成年 HNC 患者进行了单机构回顾性审计。将有 CWL 和 RFT 的患者与无管患者的 CSS 进行比较。还对 RFT 插入的预测分析进行了评估。53%的患者发生 CWL，88%有 RFT 的患者发生 CWL（<0.001）。在有 CWL 的患者中，与无管患者相比，有 RFT 的患者 5 年和 10 年 CSS 更差（分别为 68%和 65%比 83%和 80%，=0.040），多变量 Cox 回归分析。同期放化疗联合 CWL 是 RFT 插入的最强预测因素（=0.003）。CWL 与 RFT 的存在对 CSS 有负面影响。CWL 可能是 RFT 插入的触发因素之一，但无管患者的 CSS 更好。这可能是由于有 RFT 的患者体重下降程度更高，因此早期插入以防止此类损失似乎是合理的。
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