Impact of Prophylaxis Percutaneous Endoscopic Gastrostomy on the Survival Rate of Patients with Nasopharyngeal Cancer Stage II to IV Undergoing Definitive Concurrent Chemo-Radiation Therapy
Pattarapuntakul T, MD1, Chamroonkul N, MD2, Sripongpan P, MD2, Netinatsuton N, MD1, Tangthongkum M, MD3, Ovartlarnporn B, MD1
Affiliation : 1 NKC institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand 2 Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand 3 Division of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
Background : The benefits of prophylaxis percutaneous endoscopic gastrostomy (PPEG) in term of survival and nutritional status
in nasopharyngeal cancer (NPC) are still unknown.
Objective : To assess the impact of PPEG on the survival rate, completed treatment rate (CTR), and the nutritional status of patients
with NPC stage II to IV, having been treated with concurrent chemo-radiation therapy (CCRT).
Materials and Methods : All of the computerized medical records of NPC stage II to IV patients treated with CCRT, without severe
malnourishment (BMI <18.5 kg/m2) from January 2007 to September 2011 were retrospectively reviewed. PPEG is defined as PEG
tube placement prior to CCRT. The 1- and 3-year overall survival rates, completed treatment rate and nutritional status (body
weight) during CCRT, between the PPEG group and the non-PPEG group, were compared. PEG utility rate and PEG related
complications were collected.
Results : Two hundred and ninety-two patients (216 males, 76 females, with the mean age of 48.7+13.7 years) were enrolled, 192
(65%) in the PPEG group, and 100 patients in the non-PPEG group. The demographic data, tumor staging, and ECOG scores were
similar between the 2 groups, and the 3-year overall survival rates of the PPEG and non-PPEG group were not significantly different.
Mean weight reduction, and the proportion of patients with >10% weight reduction in the non-PPEG was significantly higher
during weeks 4 to 7 of CCRT. The PPEG group showed a trend of having a higher CTR than the non-PPEG group (94.3% vs. 87%, p
= 0.055). In the group of PPEG, PEG related complications occurred in 44 patients (23%) and severe complications were observed
in 6 patients (3.1%). The utility rate of gastrostomy tube, as the route of feeding during CCRT, was 96.3% (155/161).
Conclusion : PPEG lessened weight reduction in NPC patients, stage II to IV during CCRT, and showed a trend of improving the
completed treatment rate with minimal serious complications. However, there was no difference in terms of overall survival.
Keywords : Prophylaxis percutaneous endoscopic gastrostomy, Nasopharyngeal carcinoma, Concurrent chemo-radiation, Survival
