Impact of prophylactic gastrostomy or reactive NG tube upon patient-reported long term swallow function following chemoradiotherapy for oropharyngeal carcinoma: A matched pair analysis.

Published on Aug 1, 2016in Oral Oncology3.979
· DOI :10.1016/J.ORALONCOLOGY.2016.06.007
Brinda Sethugavalar1
Estimated H-index: 1
,
Mark Teo14
Estimated H-index: 14
+ 4 AuthorsRobin Prestwich28
Estimated H-index: 28
Sources
Abstract
Summary Objectives The purpose of this matched pair analysis is to assess patient-reported long term swallow function following chemoradiotherapy for locally advanced oropharyngeal cancer in relation to the use of a prophylactic gastrostomy or reactive nasogastric (NG) tube. Materials and methods The MD Anderson Dysphagia Inventory (MDADI) was posted to 68 consecutive patients with stage III/IV oropharyngeal squamous cell carcinoma who had completed parotid sparing intensity modulated radiotherapy with concurrent chemotherapy between 2010 and 2012, had not required therapeutic enteral feeding prior to treatment, minimum 2 years follow up post treatment, and who were disease free. 59/68 replies were received, and a matched pair analysis (matching for T and N stage) was performed for 52 patients, 26 managed with a prophylactic gastrostomy and 26 with an approach of an NG tube as needed. Results There were no significant differences in patient demographics, pre-treatment diet and treatment factors between the two groups. Patient-reported swallowing function measured using the MDADI was superior for patients managed with an NG tube as required compared with a prophylactic gastrostomy: overall composite score 68.1 versus 59.4 ( p  = 0.04), global score 67.7 versus 60 ( p  = 0.04), emotional subscale 73.5 versus 60.4 ( p p p  = 0.38). Conclusions Compared with an approach of an NG tube as required, the use of a prophylactic gastrostomy was associated with inferior long term patient-reported long term swallow outcomes.
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