Time Factor and the Role of Gastrostomy Tube Placement in the Treatment of Advanced Head and Neck Tumors

Aim: Time factor in the treatment of advanced head and neck tumors undoubtedly affects local tumor control and overall survival of treated patients. The aim of this work was to analyse individual time periods of radiation therapy, emphasising the role of enteral nutrition via gastrostomy tube (GT).

Methods: Patients with cancer of head and neck region are in 70-80% cases diagnosed in locally advanced stage; the majority of cases are complicated by various degrees of malnutrition. Radiation therapy of malignancies in the head and neck region is accompanied by considerable acute toxicity, manifested by severe odynophagia, dysphagia, xerostomia and/or dysgeusia. Toxicity of chemoradiotherapy worsens the unfavourable nutritional state of patients and it often causes unplanned treatment gaps. Prophylactic GT placement effectively mitigates adverse effects of radiation therapy. In the retrospective analysis of 83 patients, the effect of GT on individual intervals of concomitant chemo-radiotherapy was evaluated. We focused on the time interval between diagnosis and the beginning of the treatment. Next, the length of treatment gaps, caused by acute toxicity, was compared between the two groups of patients - without GT and with GT. Finally, body weight loss during the treatment and overall survival were compared in these two groups of patients.

Results: The time interval diagnosis-chemoradiotherapy for patients diagnosed and treated in University Hospital Martin (UNM) was on average 35.1 days, compared to 49.6 days for patients who were diagnosed in other hospitals and treated in UNM. Toxicity of radiotherapy in the treatment of patients with malignancies in the head and neck region is associated with a high risk of treatment interruptions. Treatment gaps caused by acute radiotoxicity were on average 4.1 days for patients with inserted GT, compared to 6.8 days for patients without GT. Weight loss was on average 4.4 kg for patients with GT, compared to 7.0 kg in the reference group of patients without GT. Median survival in the group of patients with GT and without GT was 787 and 366 days, respectively.

Conclusion: The results of retrospective study confirm that gastrostomy tube placed before the start of radiotherapy treatment markedly affects the time intervals in the treatment of head and neck cancers. It reduces undesired gaps in concomitant chemoradiotherapy and consequently it improves overall survival. Gastrostomy tube nutrition is an established method to provide patients with enteral nutrition and hydratation during manifestations of chemoradiotherapy toxicity, which means reduction of weight loss during the treatment, improvement of morbidity, less frequent need for parenteral support treatment - so that the majority of patients can undergo an outpatient treatment and retain an adequate quality of life.