Percutaneous Endoscopic Gastrostomy in Oropharyngeal Cancer Patients Treated With Intensity-Modulated Radiotherapy With Concurrent Chemotherapy
Percutaneous Endoscopic Gastrostomy in Oropharyngeal Cancer Patients Treated With Intensity-Modulated Radiotherapy With Concurrent Chemotherapy
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DOI：
10.1002/cncr.27633
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发表时间：
2012-12-15
期刊：
影响因子：
6.2
通讯作者：
Lee, Nancy Y.
中科院分区：
文献类型：
--
作者：
Romesser, Paul B.;Romanyshyn, Jonathan C.;Lee, Nancy Y.
背景技术背景：在接受调强放疗（IMRT）和同步化疗的口咽癌（OPC）患者中，评估了常规放置预防性经皮内镜下胃造口术（pPEG）管的临床获益。方法：从1998年到2009年，400例接受放化疗的OPC患者被纳入研究。其中，325例有pPEG，75例没有（nPEG）。评价了从基线到中期IMRT、IMRT结束、IMRT后1个月和IMRT后3个月的体重和白蛋白变化。治疗医生前瞻性记录急性和晚期毒性。研究结果：pPEG组与nPEG组在IMRT结束时（6.80 kg vs 8.38 kg，P = 0.007）、IMRT后1个月（9.06 kg vs 11.33 kg，P = 0.006）和IMRT后3个月（11.10 kg vs 13.09 kg，P = 0.044）的绝对体重减轻显著较低。这种降低体重减轻百分比的益处仅在BMI < 25的患者中持续显著。住院率（15.1% vs 26.7%，P = 0.026）和非化疗水化量（8.9升vs 17.2升，P = 0.004）存在显著差异。在白蛋白变化百分比、急性吞咽困难、急性粘膜炎、急性口干、慢性吞咽困难、放疗持续时间和总生存期方面没有差异。多变量分析指出，年龄> 55岁（P < .001）、女性（P < .001）和T3/4类疾病（P < .001）与延长PEG使用时间显著相关。结论：虽然pPEG减少了接受放化疗的OPC患者的绝对和百分比体重减轻和住院需求，但在放疗持续时间、毒性和总生存期方面没有发现差异。长期使用PEG与年龄> 55岁、女性和T3/T4肿瘤相关。Cancer 2012;118：6072-8. (C)2012年美国癌症协会
BACKGROUND: The clinical benefit of routine placement of prophylactic percutaneous endoscopic gastrostomy (pPEG) tubes was assessed in patients with oropharyngeal cancer (OPC) who are undergoing intensity-modulated radiotherapy (IMRT) with concurrent chemotherapy. METHODS: From 1998 through 2009, 400 consecutive patients with OPC who underwent chemoradiation were included. Of these, 325 had a pPEG and 75 did not (nPEG). Weight and albumin change from baseline to mid-IMRT, end of IMRT, 1 month post-IMRT, and 3 months post-IMRT were evaluated. The treating physicians prospectively recorded acute and late toxicities. RESULTS: Significantly lower absolute weight loss at end of IMRT (6.80 kg vs 8.38 kg, P = .007), 1 month post-IMRT (9.06 kg vs 11.33 kg, P = .006), and 3 months post-IMRT (11.10 kg vs 13.09 kg, P = .044) was noted in the pPEG versus nPEG groups. This benefit in reduction of percent weight loss was consistently significant only among patients with BMI < 25. Significant differences were noted in hospital admission rate (15.1% vs 26.7%, P = .026) and volume of nonchemotherapy hydration (8.9 liters vs 17.2 liters, P = .004). There were no differences in percent albumin change, acute dysphagia, acute mucositis, acute xerostomia, chronic dysphagia, radiation treatment duration, and overall survival. Multivariate analysis noted age > 55 years (P < .001), female sex (P < .001), and T3/4 category disease (P < .001) were significantly associated with prolonged PEG use. CONCLUSIONS: Although pPEG reduced absolute and percent weight loss and need for hospitalizations in our cohort of patients with OPC undergoing chemoradiation, no differences were noted in radiation treatment duration, toxicity, and overall survival. Prolonged PEG use correlated with age > 55 years, female sex, and T3/T4 tumors. Cancer 2012;118:6072-8. (C) 2012 American Cancer Society.