School of Human Movement and Nutrition Sciences, University of Queensland, Queensland, Australia.
School of Human Movement and Nutrition Sciences, University of Queensland, Queensland, Australia; Nutrition & Dietetics, Royal Brisbane & Women's Hospital, Queensland, Australia.
Clin Nutr ESPEN. 2021 Dec;46:87-98. doi: 10.1016/j.clnesp.2021.09.724. Epub 2021 Oct 2.
BACKGROUND & AIMS: Nutrition support is frequently indicated in patients with head and neck cancer (HNC). However, the optimal timing of enteral tube placement and feeding commencement is unknown. This review aims to compare the outcomes for patients with HNC undergoing curative intent radiotherapy (RT) or chemoradiotherapy (CRT) receiving either prophylactic percutaneous endoscopic gastrostomy (pPEG) tube placement/feeding or reactive enteral nutrition (rEN).
A literature search was conducted in March 2020 across PubMed, CINAHL, Embase, Web of Science, and Scopus. Randomized controlled trials (RCTs) of patients (≥18 years) with HNC who had received either pPEG or rEN were included. Outcomes examined were weight change, nutritional status, body mass index, treatment interruptions, quality of life (QoL), disease-free survival and overall survival. Study quality and certainty of evidence were assessed using the Cochrane Risk-of-bias Tool for Randomized Trials Version 2 and the Grading of Recommendations Assessment, Development and Evaluation system, respectively.
Five studies (three RCTs) (n = 298) were included and definitions of pPEG and rEN were heterogenous. pPEG was associated with a clinically important reduction in short-term critical weight loss (>10% weight loss), and significantly improved short-term QoL in patients with HNC. The timing of nutrition support commencement had no effect on all other outcomes. The overall certainty of evidence was 'moderate' for: nutritional status; treatment interruptions; short-term QoL; disease-free survival; and 'low' for all other outcomes.
Patients with HNC undergoing RT or CRT receiving pPEG tube feeding/placement were less likely to experience short-term critical weight loss and have improved short-term QoL compared to rEN. Further well-designed RCTs with consistent definitions of tube feeding protocols and the use of validated tools to evaluate nutritional status, will assist to increase the certainty of evidence and confirm the beneficial effects observed.
营养支持常用于头颈部癌症（HNC）患者。然而，肠内管放置和喂养开始的最佳时机尚不清楚。本综述旨在比较接受根治性放疗（RT）或放化疗（CRT）的 HNC 患者接受预防性经皮内镜胃造口术（pPEG）管放置/喂养或反应性肠内营养（rEN）的结果。
2020 年 3 月，我们对 PubMed、CINAHL、Embase、Web of Science 和 Scopus 进行了文献检索。纳入了接受 pPEG 或 rEN 的 HNC 患者的随机对照试验（RCT）。检查的结果是体重变化、营养状况、体重指数、治疗中断、生活质量（QoL）、无病生存率和总生存率。使用 Cochrane 随机试验偏倚风险工具 2 版和推荐评估、制定和评估系统分别评估研究质量和证据确定性。
纳入了 5 项研究（3 项 RCT）（n=298），pPEG 和 rEN 的定义存在异质性。pPEG 与短期严重体重减轻（>10%体重减轻）的临床显著减少相关，并显著改善了 HNC 患者的短期 QoL。营养支持开始的时间对所有其他结果没有影响。证据的总体确定性为“中度”：营养状况；治疗中断；短期 QoL；无病生存率；而所有其他结果的确定性为“低”。
与 rEN 相比，接受 RT 或 CRT 的 HNC 患者接受 pPEG 管喂养/放置的患者发生短期严重体重减轻的可能性较小，短期 QoL 也得到改善。进一步设计良好的 RCT，具有一致的管饲方案定义，并使用验证工具评估营养状况，将有助于提高证据的确定性，并证实观察到的有益效果。
