, Volume 30, Issue 2, pp 152–175 | Cite as

The Effect of Prophylactic Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement on Swallowing and Swallow-Related Outcomes in Patients Undergoing Radiotherapy for Head and Neck Cancer: A Systematic Review

  • Stephanie M. ShawEmail author
  • Heather Flowers
  • Brian O’Sullivan
  • Andrew Hope
  • Louis W. C. Liu
  • Rosemary Martino
Original Article


Patients undergoing radiotherapy for head and neck cancer (HNC) often experience malnutrition and dehydration during treatment. As a result, some centres place PEG tubes prophylactically (pPEG) to prevent these negative consequences. However, recent research has suggested that pPEG use may negatively affect swallowing physiology, function and/or quality of life, especially in the long term. The purpose of this study was to systematically review the literature on pPEG use in HNC patients undergoing radiotherapy and to determine its impact on swallowing-related outcomes. The following electronic databases were searched for all relevant primary research published through February 24, 2014: AMED, CINAHL, the Cochrane Library, Embase, Healthstar, Medline, and PsycINFO. Main search terms included HNC, radiotherapy, deglutition disorders, feeding tube(s), and prophylactic or elective. References for all accepted papers were hand searched to identify additional relevant research. Methodological quality was assessed using Cochrane’s Risk of Bias. At all levels, two blinded raters provided judgments. Discrepancies were resolved by consensus. The search retrieved 181 unique citations. Twenty studies met our inclusion criteria. Quality assessment revealed that all studies were at risk for bias due to non-randomized sampling and unreported or inadequate blinding. Ten studies demonstrated selection bias with significant baseline differences between pPEG patients and controls. Results regarding the frequency and severity of dysphagia and swallowing-related outcomes were varied and inconclusive. The impact of pPEG use on swallowing and swallowing-related outcomes remains unclear. Well-controlled, randomized trials are needed to determine if pPEG places patients at greater risk for developing long-term dysphagia.


Deglutition and deglutition disorders Head and neck cancer Radiotherapy Prophylactic Feeding tube Percutaneous endoscopic gastrostomy (PEG) 



The authors would like to thank Dr. Yoko Inamoto (Fujita Health University, Faculty of Rehabilitation) for her help with article translation.

Supplementary material

455_2014_9592_MOESM1_ESM.docx (43 kb)
Supplementary material 1 (DOCX 42 kb)
455_2014_9592_MOESM2_ESM.docx (736 kb)
Supplementary material 2 (DOCX 736 kb)


  1. 1.
    Forte T, Niu J, Lockwood GA, Bryant HE. Incidence trends in head and neck cancers and human papillomavirus (HPV)-associated oropharyngeal cancer in Canada, 1992–2009. Cancer Causes Control. 2012;23(8):1343–8. doi: 10.1007/s10552-012-0013-z.PubMedCrossRefGoogle Scholar
  2. 2.
    Argiris A, Karamouzis MV, Raben D, Ferris RL. Head and neck cancer. Lancet. 2008;371(9625):1695–709. doi: 10.1016/s0140-6736(08)60728-x.PubMedCrossRefGoogle Scholar
  3. 3.
    Bourhis J, Overgaard J, Audry H, Ang KK, Saunders M, Bernier J, Horiot J-C, et al. Hyperfractionated or accelerated radiotherapy in head and neck cancer: a meta-analysis. Lancet. 2006;368(9538):843–54. doi: 10.1016/s0140-6736(06)69121-6.PubMedCrossRefGoogle Scholar
  4. 4.
    Chin D, Boyle GM, Porceddu S, Theile DR, Parsons PG, Coman WB. Head and neck cancer: past, present and future. Expert Rev Anticancer Ther. 2006;6:1111–8. doi: 10.1586/14737140.6.7.1111.PubMedCrossRefGoogle Scholar
  5. 5.
    Nguyen NP, Frank C, Moltz CC, Vos P, Smith HJ, Bhamidipati PV, Karlsson U, et al. Aspiration rate following chemoradiation for head and neck cancer: an underreported occurrence. Radiother Oncol. 2006;80(3):302–6. doi: 10.1016/j.radonc.2006.07.031.PubMedCrossRefGoogle Scholar
  6. 6.
    Bachaud J-M, Cohen-Jonathan E, Alzieu C, David J-M, Serrano E, Daly-Schveitzer N. Combined postoperative radiotherapy and weekly cisplatin infusion for locally advanced head and neck carcinoma: final report of a randomized trial. Int J Radiat Oncol Biol Phys. 1996;36(5):999–1004. doi: 10.1016/S0360-3016(96)00430-0.PubMedCrossRefGoogle Scholar
  7. 7.
    Fu KK. Combined-modality therapy for head and neck cancer. Oncology. 1997;11(12):1781.PubMedGoogle Scholar
  8. 8.
    Redda MGR, Ragona R, Ricardi U, Beltramo G, Rampino M, Gabriele P, Allis S, et al. Radiotherapy alone or with concomitant daily low-dose carboplatin in locally advanced, unresectable head and neck cancer: definitive results of a phase III study with a follow-up period of up to ten years. Tumori. 2010;96:246–53. doi: 10.1700/488.5774.Google Scholar
  9. 9.
    Zackrisson B, Mercke C, Strander H, Wennerberg J, Cavallin-Ståhl E. A systematic overview of radiation therapy effects in head and neck cancer. Acta Otolaryngol. 2003;42(5–6):443–61. doi: 10.1080/02841860310014886.Google Scholar
  10. 10.
    Forastiere AA, Goepfert H, Maor M, Pajak TF, Weber R, Morrison W, Glisson B, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003;349(22):2091–8. doi: 10.1056/NEJMoa031317.PubMedCrossRefGoogle Scholar
  11. 11.
    Cooper JS, Pajak TF, Forastiere AA, Jacobs J, Campbell BH, Saxman SB, Kish JA, et al. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med. 2004;350(19):1937–44. doi: 10.1056/NEJMoa032646.PubMedCrossRefGoogle Scholar
  12. 12.
    Al-Sarraf M, Leblanc M, Giri P, Fu K, Cooper J, Vuong T, Forastiere A, et al. Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099. J Clin Oncol. 1998;16(4):1310–7.PubMedGoogle Scholar
  13. 13.
    Adelstein DJ, Li Y, Adams GL, Wagner H, Kish JA, Ensley JF, Schuller DE, et al. An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol. 2003;21(1):92–8. doi: 10.1200/jco.2003.01.008.PubMedCrossRefGoogle Scholar
  14. 14.
    Bonner JA, Harari PM, Giralt J, Azarnia N, Shin DM, Cohen RB, Jones CU, et al. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med. 2006;354(6):567–78. doi: 10.1056/NEJMoa053422.PubMedCrossRefGoogle Scholar
  15. 15.
    Alkureishi LWT, De Bree R, Ross GL. RADPLAT: an alternative to surgery? Oncologist. 2006;11(5):469–80. doi: 10.1634/theoncologist.11-5-469.PubMedCrossRefGoogle Scholar
  16. 16.
    Trotti A. Toxicity in head and neck cancer: a review of trends and issues. Int J Radiat Oncol Biol Phys. 2000;47(1):1–12. doi: 10.1016/S0360-3016(99)00558-1.PubMedCrossRefGoogle Scholar
  17. 17.
    Rosenthal DI, Mendoza TR, Chambers MS, Asper JA, Gning I, Kies MS, Weber RS, et al. Measuring head and neck cancer symptom burden: the development and validation of the M. D. Anderson symptom inventory, head and neck module. Head Neck. 2007;29(10):923–31. doi: 10.1002/hed.20602.PubMedCrossRefGoogle Scholar
  18. 18.
    Henk JM. Controlled trials of synchronous chemotherapy with radiotherapy in head and neck cancer: overview of radiation morbidity. Clin Oncol. 1997;9(5):308–12. doi: 10.1016/S0936-6555(05)80064-0.CrossRefGoogle Scholar
  19. 19.
    Trotti A, Bellm LA, Epstein JB, Frame D, Fuchs HJ, Gwede CK, Komaroff E, et al. Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review. Radiat Oncol. 2003;66(3):253–62. doi: 10.1016/S0167-8140(02)00404-8.CrossRefGoogle Scholar
  20. 20.
    Bentzen SM, Saunders MI, Dische S, Bond SJ. Radiotherapy-related early morbidity in head and neck cancer: quantitative clinical radiobiology as deduced from the CHART trial. Radiother Oncol. 2001;60(2):123–35. doi: 10.1016/s0167-8140(01)00358-9.PubMedCrossRefGoogle Scholar
  21. 21.
    Piquet M-A, Ozsahin M, Larpin I, Zouhair A, Coti P, Monney M, Monnier P, et al. Early nutritional intervention in oropharyngeal cancer patients undergoing radiotherapy. Support Care Cancer. 2002;10(6):502–4. doi: 10.1007/s00520-002-0364-1.PubMedCrossRefGoogle Scholar
  22. 22.
    Chen AM, Li B-Q, Lau DH, Farwell DG, Luu Q, Stuart K, Newman K, et al. Evaluating the role of prophylactic gastrostomy tube placement prior to definitive chemoradiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys. 2010;78(4):1026–32. doi: 10.1016/j.ijrobp.2009.09.036.PubMedCrossRefGoogle Scholar
  23. 23.
    Newman LA, Vieira F, Schwiezer V, Samant S, Murry T, Woodson G, Kumar P, et al. Eating and weight changes following chemoradiation therapy for advanced head and neck cancer. Arch Otolaryngol Head Neck Surg. 1998;124(5):589–92. doi: 10.1001/archotol.124.5.589.PubMedCrossRefGoogle Scholar
  24. 24.
    Beaver ME, Matheny KE, Roberts DB, Myers JN. Predictors of weight loss during radiation therapy. Otolaryngol Head Neck Surg. 2001;125(6):645–8. doi: 10.1067/mhn.2001.120428.PubMedCrossRefGoogle Scholar
  25. 25.
    Colasanto JM, Prasad P, Nash MA, Decker RH, Wilson LD. Nutritional support of patients undergoing radiation therapy for head and neck cancer. Oncology. 2005;19(3):371–9.PubMedGoogle Scholar
  26. 26.
    Lee JH, Machtay M, Unger LD, Weinstein GS, Weber RS, Chalian AA, Rosenthal DI. Prophylactic gastrostomy tubes in patients undergoing intensive irradiation for cancer of the head and neck. Arch Otolaryngol Head Neck Surg. 1998;124(8):871–5. doi: 10.1001/archotol.124.8.871.PubMedCrossRefGoogle Scholar
  27. 27.
    Nayel H, El-Ghoneimy E, El-Haddad S. Impact of nutritional supplementation on treatment delay and morbidity in patients with head and neck tumors treated with irradiation. Nutrition. 1992;8(1):13–8.PubMedGoogle Scholar
  28. 28.
    Haydock DA, Hill GL. Impaired wound healing in surgical patients with varying degrees of malnutrition. JPEN J Parenter Enteral Nutr. 1986;10(6):550–4. doi: 10.1177/0148607186010006550.PubMedCrossRefGoogle Scholar
  29. 29.
    Haydock DA, Hill GL. Improved wound healing response in surgical patients receiving intravenous nutrition. Br J Surg. 1987;74(4):320–3. doi: 10.1002/bjs.1800740432.PubMedCrossRefGoogle Scholar
  30. 30.
    Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr. 2008;27(1):5–15. doi: 10.1016/j.clnu.2007.10.007.PubMedCrossRefGoogle Scholar
  31. 31.
    Andreyev HJN, Norman AR, Oates J, Cunningham D. Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies? Eur J Cancer. 1998;34(4):503–9. doi: 10.1016/S0959-8049(97)10090-9.PubMedCrossRefGoogle Scholar
  32. 32.
    Norman K, Schütz T, Kemps M, Lübke HJ, Lochs H, Pirlich M. The Subjective Global Assessment reliably identifies malnutrition-related muscle dysfunction. Clin Nutr. 2005;24(1):143–50. doi: 10.1016/j.clnu.2004.08.007.PubMedCrossRefGoogle Scholar
  33. 33.
    Correia MITD, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003;22(3):235–9. doi: 10.1016/S0261-5614(02)00215-7.PubMedCrossRefGoogle Scholar
  34. 34.
    Norman K, Kirchner H, Lochs H, Pirlich M. Malnutrition affects quality of life in gastroenterology patients. World J Gastroenterol. 2006;12(21):3380. doi: 10.3748/wjg.v12.i21.3385.PubMedCentralPubMedGoogle Scholar
  35. 35.
    Marín Caro MM, Laviano A, Pichard C. Impact of nutrition on quality of life during cancer. Curr Opin Clin Nutr Metab Care. 2007;10(4):480–7. doi: 10.1097/MCO.0b013e3281e2c983.PubMedCrossRefGoogle Scholar
  36. 36.
    Ravasco P, Monteiro-Grillo I, Camilo ME. Does nutrition influence quality of life in cancer patients undergoing radiotherapy? Radiat Oncol. 2003;67(2):213–20. doi: 10.1016/S0167-8140(03)00040-9.CrossRefGoogle Scholar
  37. 37.
    Lees J. Nasogastric and percutaneous endoscopic gastrostomy feeding in head and neck cancer patients receiving radiotherapy treatment at a regional oncology unit: a two year study. Eur J Cancer Care. 1997;6(1):45–9. doi: 10.1111/j.1365-2354.1997.tb00268.x.CrossRefGoogle Scholar
  38. 38.
    Magné N, Marcy P, Foa C, Falewee M, Schneider M, Demard F, Bensadoun R. Comparison between nasogastric tube feeding and percutaneous fluoroscopic gastrostomy in advanced head and neck cancer patients. Eur Arch Otorhinolaryngol. 2001;258(2):89–92. doi: 10.1007/s004050000311.PubMedCrossRefGoogle Scholar
  39. 39.
    Raykher A, Correa L, Russo L, Brown P, Lee N, Pfister D, Gerdes H, et al. The role of pretreatment percutaneous endoscopic gastrostomy in facilitating therapy of head and neck cancer and optimizing the body mass index of the obese patient. JPEN J Parenter Enteral Nutr. 2009;33(4):404–10. doi: 10.1177/0148607108327525.PubMedCrossRefGoogle Scholar
  40. 40.
    National Comprehensive Cancer Network clinical practice guidelines in oncology (NCCN Guidelines®): head and neck cancers version 1.2012, 2012. Accessed April 8, 2013.
  41. 41.
    Nguyen N, Frank C, Moltz C, Vos P, Smith H, Nguyen P, Martinez T, et al. Analysis of factors influencing aspiration risk following chemoradiation for oropharyngeal cancer. Br J Radiol. 2009;82(980):675–80. doi: 10.1259/bjr/72852974.PubMedCrossRefGoogle Scholar
  42. 42.
    Lee H, Havrila C, Bravo V, Shantz K, Diaz K, Larner J, Read P. Effect of oral nutritional supplementation on weight loss and percutaneous endoscopic gastrostomy tube rates in patients treated with radiotherapy for oropharyngeal carcinoma. Support Care Cancer. 2008;16(3):285–9. doi: 10.1007/s00520-007-0313-0.PubMedCrossRefGoogle Scholar
  43. 43.
    Wiggenraad RGJ, Flierman L, Goossens A, Brand R, Verschuur HP, Croll GA, Moser LEC, et al. Prophylactic gastrostomy placement and early tube feeding may limit loss of weight during chemoradiotherapy for advanced head and neck cancer, a preliminary study. Clin Otolaryngol. 2007;32(5):384–90. doi: 10.1111/j.1749-4486.2007.01533.x.PubMedCrossRefGoogle Scholar
  44. 44.
    Berlach DM, Nguyen N, Cury F, Al Halabi H, Shenouda G. Comparison of prophylactic and emergent percutaneous endoscopic gastrostomy tube placement in patients treated with chemotherapy and radiation for head and neck cancer. Int J Radiat Oncol Biol Phys. 2010;78(3 Suppl. 1):437.CrossRefGoogle Scholar
  45. 45.
    Paccagnella A, Morello M, Da Mosto MC, Baruffi C, Marcon ML, Gava A, Baggio V, et al. Early nutritional intervention improves treatment tolerance and outcomes in head and neck cancer patients undergoing concurrent chemoradiotherapy. Support Care Cancer. 2010;18(7):837–45. doi: 10.1007/s00520-009-0717-0.PubMedCrossRefGoogle Scholar
  46. 46.
    Hughes BGM, Jain VK, Brown T, Spurgin A-L, Hartnett G, Keller J, Tripcony L, et al. Decreased hospital stay and significant cost savings after routine use of prophylactic gastrostomy for high-risk patients with head and neck cancer receiving chemoradiotherapy at a tertiary cancer institution. Head Neck. 2013;35(3):436–42. doi: 10.1002/hed.22992.PubMedCrossRefGoogle Scholar
  47. 47.
    George A, Abhyankar A, Hari C. Percutaneous endoscopic gastrostomy (PEG) tube insertion in head and neck cancer (HNC) patients: a cause for delay. Otorhinolaryngologist. 2011;3(3):125–6.Google Scholar
  48. 48.
    Cady J. Nutritional support during radiotherapy for head and neck cancer: the role of prophylactic feeding tube placement. Clin J Oncol Nurs. 2007;11(6):875–80. doi: 10.1188/07.cjon.875-880.PubMedCrossRefGoogle Scholar
  49. 49.
    Moor JW, Patterson J, Kelly C, Paleri V. Prophylactic gastrostomy before chemoradiation in advanced head and neck cancer: a multiprofessional web-based survey to identify current practice and to analyse decision making. Clin Oncol. 2010;22(3):192–8. doi: 10.1016/j.clon.2010.01.008.CrossRefGoogle Scholar
  50. 50.
    Back M, Raymond B, Ko F, Chin S, Veivers D, Wignall A, Eade T. Impact of prophylactic PEG tubes on nutritional outcomes at 12 months following IMRT for locoregionally advanced head and neck cancer. J Med Imaging Radiat Oncol. 2009;53:A199.Google Scholar
  51. 51.
    Huang DT, Thomas G, Wilson WR. Stomal seeding by percutaneous endoscopic gastrostomy in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg. 1992;118(6):658–9. doi: 10.1001/archotol.1992.01880060108022.PubMedCrossRefGoogle Scholar
  52. 52.
    Bushnell L, White TW, Hunter JG. Metastatic implantation of laryngeal carcinoma at a PEG exit site. Gastrointest Endosc. 1991;37(4):480–2. doi: 10.1016/S0016-5107(91)70787-6.PubMedCrossRefGoogle Scholar
  53. 53.
    Meurer MF, Kenady DE. Metastatic head and neck carcinoma in a percutaneous gastrostomy site. Head Neck. 1993;15(1):70–3. doi: 10.1002/hed.2880150116.PubMedCrossRefGoogle Scholar
  54. 54.
    Preyer S, Thul P. Gastric metastasis of squamous cell carcinoma of the head and neck after percutaneous endoscopic gastrostomy: report of a case. Endoscopy. 1989;21(6):295. doi: 10.1055/s-2007-1012974.PubMedCrossRefGoogle Scholar
  55. 55.
    Laccoureye O, Merite-Drancy A, Chabardes E, Carnot FO. Implantation metastasis following percutaneous endoscopic gastrostomy. J Laryngol Otol. 1993;107:946–9. doi: 10.1017/S0022215100124879.CrossRefGoogle Scholar
  56. 56.
    Sharma P, Berry S, Wilson K, Neale H, Fink A. Metastatic implantation of an oral squamous-cell carcinoma at a percutaneous endoscopic gastrostomy site. Surg Endosc. 1994;8(10):1232–5. doi: 10.1007/BF00591059.PubMedCrossRefGoogle Scholar
  57. 57.
    Thorburn D, Karim SN, Soutar DS, Mills PR. Tumour seeding following percutaneous endoscopic gastrostomy placement in head and neck cancer. Postgrad Med J. 1997;73(861):430–2. doi: 10.1136/pgmj.73.861.430.PubMedCentralPubMedCrossRefGoogle Scholar
  58. 58.
    Schiano T, Pfister D, Harrison L, Shike M. Neoplastic seeding as a complication of percutaneous endoscopic gastrostomy. Am J Gastroenterol. 1994;89(1):131–3.PubMedGoogle Scholar
  59. 59.
    Schneider AM, Loggie BW. Metastatic head and neck cancer to the percutaneous endoscopic gastrostomy exit site: a case report and review of the literature. Am Surg. 1997;63(6):481.PubMedGoogle Scholar
  60. 60.
    Riera L, Sandiumenge A, Calvo C, Bordas J, Alobid I, Llach J, Bernal M. Percutaneous endoscopic gastrostomy in head and neck cancer patients. J Otorhinolaryngol. 2002;64(1):32–4. doi: 10.1159/000049265.Google Scholar
  61. 61.
    Corry J, Poon W, Mcphee N, Milner AD, Cruickshank D, Porceddu SV, Rischin D, et al. Prospective study of percutaneous endoscopic gastrostomy tubes versus nasogastric tubes for enteral feeding in patients with head and neck cancer undergoing (chemo)radiation. Head Neck. 2009;31(7):867–76. doi: 10.1002/hed.21044.PubMedCrossRefGoogle Scholar
  62. 62.
    Rustom IK, Jebreel A, Tayyab M, England RJA, Stafford ND. Percutaneous endoscopic, radiological and surgical gastrostomy tubes: a comparison study in head and neck cancer patients. J Laryngol Otol. 2006;120(6):463–6. doi: 10.1017/S0022215106000661.PubMedCrossRefGoogle Scholar
  63. 63.
    Grant D, Bradley P, Pothier D, Bailey D, Caldera S, Baldwin D, Birchall M. Complications following gastrostomy tube insertion in patients with head and neck cancer: a prospective multi-institution study, systematic review and meta-analysis. Clin Otolaryngol. 2009;34(2):103–12. doi: 10.1111/j.1749-4486.2009.01889.x.PubMedCrossRefGoogle Scholar
  64. 64.
    Pruthi D, Duerksen DR, Singh H. The practice of gastrostomy tube placement across a Canadian regional health authority. Am J Gastroenterol. 2010;105(7):1541–50. doi: 10.1038/ajg.2009.756.PubMedCrossRefGoogle Scholar
  65. 65.
    Callahan CM, Buchanan NN, Stump TE. Healthcare costs associated with percutaneous endoscopic gastrostomy among older adults in a defined community. J Am Geriatr Soc. 2001;49(11):1525–9. doi: 10.1046/j.1532-5415.2001.4911248.x.PubMedCrossRefGoogle Scholar
  66. 66.
    Madhoun MF, Blankenship MM, Blankenship DM, Krempl GA, Tierney WM. Prophylactic PEG placement in head and neck cancer: how many feeding tubes are unused (and unnecessary)? World J Gastroenterol. 2011;17(8):1004–1008. doi:  10.3748/wjg.v17.i8.1004
  67. 67.
    Langmore S, Krisciunas GP, Miloro KV, Evans SR, Cheng DM. Does PEG use cause dysphagia in head and neck cancer patients? Dysphagia. 2012;27(2):251–9. doi: 10.1007/s00455-011-9360-2.PubMedCrossRefGoogle Scholar
  68. 68.
    Carnaby-Mann G, Crary MA, Schmalfuss I, Amdur R. Pharyngocise: randomized controlled trial of preventative exercises to maintain muscle structure and swallowing function during head-and-neck chemoradiotherapy. Int J Radiat Oncol Biol Phys. 2012;83(1):210–9. doi: 10.1016/j.ijrobp.2011.06.1954.PubMedCrossRefGoogle Scholar
  69. 69.
    Koyfman SA, Adelstein DJ. Enteral feeding tubes in patients undergoing definitive chemoradiation therapy for head-and-neck cancer: a critical review. Int J Radiat Oncol Biol Phys. 2012;84(3):581–9. doi: 10.1016/j.ijrobp.2012.03.053.PubMedCrossRefGoogle Scholar
  70. 70.
    Robbins J, Butler SG, Daniels SK, Diez Gross R, Langmore S, Lazarus CL, Martin-Harris B, et al. Swallowing and dysphagia rehabilitation: translating principles of neural plasticity into clinically oriented evidence. J Speech Lang Hear Res. 2008;51(1):S276–300. doi: 10.1044/1092-4388(2008/021).PubMedCrossRefGoogle Scholar
  71. 71.
    Silander E, Jacobsson I, Berteus-Forslund H, Hammerlid E. Energy intake and sources of nutritional support in patients with head and neck cancer-a randomised longitudinal study. Eur J Clin Nutr. 2013;67(1):47–52. doi: 10.1038/ejcn.2012.172.PubMedCrossRefGoogle Scholar
  72. 72.
    Silander E, Nyman J, Bove M, Johansson L, Larsson S, Hammerlid E. Impact of prophylactic percutaneous endoscopic gastrostomy on malnutrition and quality of life in patients with head and neck cancer: a randomized study. Head Neck. 2012;34(1):1–9. doi: 10.1002/hed.21700.PubMedCrossRefGoogle Scholar
  73. 73.
    Langmore S, Vasquez Miloro K, Kriscuinas G. Prophylactic vs late PEG placement in head and neck cancer patients. Dysphagia. 2009;24(4):449.CrossRefGoogle Scholar
  74. 74.
    Paleri V, Patterson J. Use of gastrostomy in head and neck cancer: a systematic review to identify areas for future research. Clin Otolaryngol. 2010;35(3):177–89. doi: 10.1111/j.1749-4486.2010.02128.x.PubMedCrossRefGoogle Scholar
  75. 75.
    Locher JL, Bonner JA, Carroll WR, Caudell JJ, Keith JN, Kilgore ML, Ritchie CS, et al. Prophylactic percutaneous endoscopic gastrostomy tube placement in treatment of head and neck cancer: a comprehensive review and call for evidence-based medicine. JPEN J Parenter Enteral Nutr. 2011;35(3):365–74. doi: 10.1177/0148607110377097.PubMedCrossRefGoogle Scholar
  76. 76.
    Orphanidou C, Biggs K, Johnston M, Wright J, Bowman A, Hotte S, Esau A, et al. Prophylactic feeding tubes for patients with locally advanced head-and-neck cancer undergoing combined chemotherapy and radiotherapy: systematic review and recommendations for clinical practice. Curr Oncol. 2011;18(4):e191–201. doi: 10.3747/co.v18i4.749.PubMedCentralPubMedCrossRefGoogle Scholar
  77. 77.
    Nugent B, Lewis S, O’sullivan JM. Enteral feeding methods for nutritional management in patients with head and neck cancers being treated with radiotherapy and/or chemotherapy. Cochrane Database Syst Rev. 2013;1:1–18. doi: 10.1002/14651858.CD007904.pub3.Google Scholar
  78. 78.
    Raber-Durlacher J, Brennan M, Verdonck-De Leeuw I, Gibson R, Eilers J, Waltimo T, Bots C, et al. Swallowing dysfunction in cancer patients. Support Care Cancer. 2012;20(3):433–43. doi: 10.1007/s00520-011-1342-2.PubMedCentralPubMedCrossRefGoogle Scholar
  79. 79.
    Cheng SS, Terrell JE, Bradford CR, Ronis DL, Fowler KE, Prince ME, Teknos TN, et al. Variables associated with feeding tube placement in head and neck cancer. Arch Otolaryngol Head Neck Surg. 2006;132(6):655–61. doi: 10.1001/archotol.132.6.655.PubMedCrossRefGoogle Scholar
  80. 80.
    Higgins JPT, Altman DG. Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S, editors. Cochrane handbook for systematic reviews of interventions. Chichester: Wiley; 2008. p. 187–241.CrossRefGoogle Scholar
  81. 81.
    Berlach D, Nguyen NT, Al Halabi H, Cury F, Shenouda G. Comparison of prophylactic and urgent percutaneous gastrostomy tube placement in patients treated with combined radiation and chemotherapy for head and neck cancer. Radiother Oncol. 2010;96:S53.Google Scholar
  82. 82.
    Romesser PT, Setton M, Schupak J, Gelblum K, Rao D, Sherman S, Lee E. Dysphagia quality of life scores and treatment outcomes in oropharyngeal cancer patients: is it time to reconsider the prophylactic percutaneous endoscopic gastrostomy? Int J Radiat Oncol Biol Phys. 2014;88(2):470.CrossRefGoogle Scholar
  83. 83.
    Oozeer NB, Corsar K, Glore RJ, Penney S, Patterson J, Paleri V. The impact of enteral feeding route on patient-reported long term swallowing outcome after chemoradiation for head and neck cancer. Oral Oncol. 2011;47(10):980–3. doi: 10.1016/j.oraloncology.2011.07.011.PubMedCrossRefGoogle Scholar
  84. 84.
    Quon HCM, Martens C, Butler A, Stimpson J, Duerksen R, Campbell-Enns D. Impact of feeding tubes on prospective functional outcomes in patients with locally-advanced head-and-neck cancer undergoing radiation therapy. Int J Radiat Oncol Biol Phys. 2013;87(2 Suppl. 1):S143.CrossRefGoogle Scholar
  85. 85.
    Sanguineti GR, Gunn N, Ricchetti B, Fiorino F. Predictors of PEG dependence after IMRT±chemotherapy for oropharyngeal cancer. Radiat Oncol. 2013;107(3):300–4. doi: 10.1016/j.radonc.2013.05.021.CrossRefGoogle Scholar
  86. 86.
    Chin S, Raymond B, Ko F, Eade T, Back M. Understanding the patient experience with prophylactic PEG tubes during intensity modulated radiation therapy for locoregionally advanced head and neck cancer. J Med Imaging Radiat Oncol. 2009;53:A100.CrossRefGoogle Scholar
  87. 87.
    Romesser PB, Romanyshyn JC, Schupak KD, Setton J, Riaz N, Wolden SL, Gelblum DY, et al. Percutaneous endoscopic gastrostomy in oropharyngeal cancer patients treated with intensity-modulated radiotherapy with concurrent chemotherapy. Cancer. 2012;118(24):6072–8. doi: 10.1002/cncr.27633.PubMedCrossRefGoogle Scholar
  88. 88.
    Williams GF, Teo MTW, Sen M, Dyker KE, Coyle C, Prestwich RJD. Enteral feeding outcomes after chemoradiotherapy for oropharynx cancer: a role for a prophylactic gastrostomy? Oral Oncol. 2012;48(5):434–40. doi: 10.1016/j.oraloncology.2011.11.022.PubMedCrossRefGoogle Scholar
  89. 89.
    Beer KT, Krause KB, Zuercher T, Stanga Z. Early percutaneous endoscopic gastrostomy insertion maintains nutritional state in patients with aerodigestive tract cancer. Nutr Cancer. 2005;52(1):29–34. doi: 10.1207/s15327914nc5201_4.PubMedCrossRefGoogle Scholar
  90. 90.
    Olson R, Karam I, Wilson G, Bowman A, Lee C, Wong F. Population-based comparison of two feeding tube approaches for head and neck cancer patients receiving concurrent systemic-radiation therapy: is a prophylactic feeding tube approach harmful or helpful? Support Care Cancer. 2013;21(12):3433–9. doi: 10.1007/s00520-013-1936-y.PubMedCrossRefGoogle Scholar
  91. 91.
    Rutter CE, Yovino S, Taylor R, Wolf J, Cullen KJ, Ord R, Athas M, et al. Impact of early percutaneous endoscopic gastrostomy tube placement on nutritional status and hospitalization in patients with head and neck cancer receiving definitive chemoradiation therapy. Head Neck. 2011;33(10):1441–7. doi: 10.1002/hed.21624.PubMedCrossRefGoogle Scholar
  92. 92.
    Prestwich RJD, Teo MTW, Gilbert A, Williams G, Dyker KE, Sen M. Long-term swallow function after chemoradiotherapy for oropharyngeal cancer: the influence of a prophylactic gastrostomy or reactive nasogastric tube. Clin Oncol. 2014;26(2):103–9. doi: 10.1016/j.clon.2013.10.005.CrossRefGoogle Scholar
  93. 93.
    Romesser PB, Tam MM, Zhang Z, Setton J, Spratt DE, Schupak KD, Gelblum DY, et al. Prospective dysphagia quality of life scores and treatment outcomes in oropharyngeal cancer patients: is it time to reconsider the prophylactic percutaneous endoscopic gastrostomy? Int J Radiat Oncol Biol Phys. 2013;87(2 Suppl. 1):S131.CrossRefGoogle Scholar
  94. 94.
    Morton RP, Crowder VL, Mawdsley R, Ong E, Izzard M. Elective gastrostomy, nutritional status and quality of life in advanced head and neck cancer patients receiving chemoradiotherapy. Aust N Z J Surg. 2009;79(10):713–8. doi: 10.1111/j.1445-2197.2009.05056.x.CrossRefGoogle Scholar
  95. 95.
    Pohar SS, Demarcantonio M, Crandley E, Wadsworth JT, Karakla D. Prophylactic PEG tube and swallowing following chemoradiation. Int J Radiat Oncol Biol Phys. 2010;78(3 Suppl. 1):S456.CrossRefGoogle Scholar
  96. 96.
    Chen AM, Chen LM, Vaughan A, Farwell DG, Luu Q, Purdy JA, Vijayakumar S. Head and neck cancer among lifelong never-smokers and ever-smokers: matched-pair analysis of outcomes after radiation therapy. Am J Clin Oncol. 2010;34(3):270–5. doi: 10.1097/COC.0b013e3181dea40b.CrossRefGoogle Scholar
  97. 97.
    Tracy JF, Logemann JA, Kahrilas PJ, Jacob P, Kobara M, Krugler C. Preliminary observations on the effects of age on oropharyngeal deglutition. Dysphagia. 1989;4(2):90–4. doi: 10.1007/BF02407151.PubMedCrossRefGoogle Scholar
  98. 98.
    Ekberg O, Feinberg M. Altered swallowing function in elderly patients without dysphagia: radiologic findings in 56 cases. Am J Roentgenol. 1991;156(6):1181–4.CrossRefGoogle Scholar
  99. 99.
    Jager-Wittenaar HT, Dijkstra PU, Vissink A, Van Der Laan BF, Van Oort RP, Roodenburg JL. Critical weight loss in head and neck cancer-prevalence and risk factors at diagnosis: an explorative study. Support Care Cancer. 2007;15(9):1045–50. doi: 10.1007/s00520-006-0212-9.PubMedCrossRefGoogle Scholar
  100. 100.
    Caudell JJ, Schaner PE, Meredith RF, Locher JL, Nabell LM, Carroll WR, Magnuson JS, et al. Factors associated with long-term dysphagia after definitive radiotherapy for locally advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2009;73(2):410–5. doi: 10.1016/j.ijrobp.2008.04.048.PubMedCrossRefGoogle Scholar
  101. 101.
    Dirix P, Abbeel S, Vanstraelen B, Hermans R, Nuyts S. Dysphagia after chemoradiotherapy for head-and-neck squamous cell carcinoma: dose-effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys. 2009;75(2):385–92. doi: 10.1016/j.ijrobp.2008.11.041.PubMedCrossRefGoogle Scholar
  102. 102.
    Machtay M, Moughan J, Trotti A, Garden AS, Weber RS, Cooper JS, Forastiere A, et al. Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol. 2008;26(21):3582–9. doi: 10.1200/jco.2007.14.8841.PubMedCrossRefGoogle Scholar
  103. 103.
    McRackan TR, Watkins JM, Herrin AE, Garrett-Mayer EM, Sharma AK, Day TA, Gillespie MB. Effect of body mass index on chemoradiation outcomes in head and neck cancer. Laryngoscope. 2008;118(7):1180–5. doi: 10.1097/MLG.0b013e31816fca5c.PubMedCrossRefGoogle Scholar
  104. 104.
    Pildal J, Hróbjartsson A, Jørgensen K, Hilden J, Altman D, Gøtzsche P. Impact of allocation concealment on conclusions drawn from meta-analyses of randomized trials. Int J Epidemiol. 2007;36(4):847–57. doi: 10.1093/ije/dym087.PubMedCrossRefGoogle Scholar
  105. 105.
    Hewitt C, Hahn S, Torgerson DJ, Watson J, Bland JM. Adequacy and reporting of allocation concealment: review of recent trials published in four general medical journals. BMJ. 2005;330(7499):1057–8. doi: 10.1136/bmj.38413.576713.AE.PubMedCentralPubMedCrossRefGoogle Scholar
  106. 106.
    Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA. 1995;273(5):408–12. doi: 10.1001/jama.1995.03520290060030.PubMedCrossRefGoogle Scholar
  107. 107.
    Schulz KF, Grimes DA. Allocation concealment in randomised trials: defending against deciphering. Lancet. 2002;359(9306):614–8. doi: 10.1016/S0140-6736(02)07750-4.PubMedCrossRefGoogle Scholar
  108. 108.
    Wood L, Egger M, Gluud LL, Schulz KF, Jüni P, Altman DG, Gluud C, et al. Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta-epidemiological study. BMJ. 2008;336(7644):601–5. doi: 10.1136/bmj.39465.451748.AD.PubMedCentralPubMedCrossRefGoogle Scholar
  109. 109.
    Roe JWG, Carding PN, Dwivedi RC, Kazi RA, Rhys-Evans PH, Harrington KJ, Nutting CM. Swallowing outcomes following Intensity Modulated Radiation Therapy (IMRT) for head and neck cancer: a systematic review. Oral Oncol. 2010;46(10):727–33. doi: 10.1016/j.oraloncology.2010.07.012.PubMedCrossRefGoogle Scholar
  110. 110.
    Logemann JA, Rademaker AW, Pauloski BR, Lazarus CL, Mittal BB, Brockstein B, Maccracken E, et al. Site of disease and treatment protocol as correlates of swallowing function in patients with head and neck cancer treated with chemoradiation. Head Neck. 2006;28(1):64–73. doi: 10.1002/hed.20299.PubMedCentralPubMedCrossRefGoogle Scholar
  111. 111.
    Lowery SD. Assessment and measurement tools used in the evaluation of swallowing. Curr Opin Otolaryngol Head Neck Surg. 2001;9(3):134–8.CrossRefGoogle Scholar
  112. 112.
    Eisbruch A, Lyden T, Bradford CR, Dawson LA, Haxer MJ, Miller AE, Teknos TN, et al. Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2002;53(1):23–8. doi: 10.1016/S0360-3016(02)02712-8.PubMedCrossRefGoogle Scholar
  113. 113.
    Jensen K, Bonde Jensen A, Grau C. The relationship between observer-based toxicity scoring and patient assessed symptom severity after treatment for head and neck cancer. A correlative cross sectional study of the DAHANCA toxicity scoring system and the EORTC quality of life questionnaires. Radiother Oncol. 2006;78(3):298–305. doi: 10.1016/j.radonc.2006.02.005.PubMedCrossRefGoogle Scholar
  114. 114.
    Lazarescu A, Karamanolis G, Aprile L, De Oliveira RB, Dantas R, Sifrim D. Perception of dysphagia: lack of correlation with objective measurements of esophageal function. Neurogastroenterol Motil. 2010;22(12):1292-e1337. doi: 10.1111/j.1365-2982.2010.01578.x.CrossRefGoogle Scholar
  115. 115.
    Nguyen NP, Moltz CC, Frank C, Vos P, Smith HJ, Karlsson U, Dutta S, et al. Dysphagia following chemoradiation for locally advanced head and neck cancer. Ann Oncol. 2004;15(3):383–8. doi: 10.1093/annonc/mdh101.PubMedCrossRefGoogle Scholar
  116. 116.
    Lewis SL, Brody R, Touger-Decker R, Parrott JS, Epstein J. Feeding tube use in patients with head and neck cancer. Head Neck. 2013;. doi: 10.1002/hed.23538.PubMedCentralGoogle Scholar
  117. 117.
    Kramer S, Newcomb M, Hessler J, Siddiqui F. Prophylactic versus reactive PEG tube placement in head and neck cancer. Otolaryngol Head Neck Surg. 2014;150(3):407–12. doi: 10.1177/0194599813517081.PubMedCrossRefGoogle Scholar
  118. 118.
    Amin N, Reddy K, Westerly D, Raben D, Dewitt P, Chen C. Sparing the larynx and esophageal inlet expedites feeding tube removal in patients with stage III–IV oropharyngeal squamous cell carcinoma treated with intensity-modulated radiotherapy. Laryngoscope. 2012;122(12):2736–42. doi: 10.1002/lary.23597.PubMedCrossRefGoogle Scholar
  119. 119.
    Bhayani MK, Hutcheson KA, Barringer DA, Lisec A, Alvarez CP, Roberts DB, Lai SY, et al. Gastrostomy tube placement in patients with oropharyngeal carcinoma treated with radiotherapy or chemoradiotherapy: factors affecting placement and dependence. 2013;35(11):1634–40. doi: 10.1002/hed.23200.
  120. 120.
    Bhayani MK, Hutcheson KA, Barringer DA, Roberts DB, Lewin JS, Lai SY. Gastrostomy tube placement in patients with hypopharyngeal cancer treated with radiotherapy or chemoradiotherapy: factors affecting placement and dependence. 2013;35(11):1641–46. doi: 10.1002/hed.23199.
  121. 121.
    Magnuson JS, Durst J, Rosenthal EL, Carroll WR, Ritchie CS, Kilgore ML, Locher JL. Increased likelihood of long-term gastrostomy tube dependence in head and neck cancer survivors without partners. Head Neck. 2013;35(3):420–5. doi: 10.1002/hed.22996.PubMedCentralPubMedCrossRefGoogle Scholar
  122. 122.
    Kiss NK, Krishnasamy M, Loeliger J, Granados A, Dutu G, Corry J. A dietitian-led clinic for patients receiving (chemo)radiotherapy for head and neck cancer. Support Care Cancer. 2012;20(9):2111–20. doi: 10.1007/s00520-011-1321-7.PubMedCrossRefGoogle Scholar
  123. 123.
    Bjordal K, Hammerlid E, Ahlner-Elmqvist M, De Graeff A, Boysen M, Evensen JF, Biörklund A, et al. Quality of life in head and neck cancer patients: validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-H&N35. J Clin Oncol. 1999;17(3):1008.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Stephanie M. Shaw
    • 1
    Email author
  • Heather Flowers
    • 1
  • Brian O’Sullivan
    • 2
  • Andrew Hope
    • 2
  • Louis W. C. Liu
    • 3
  • Rosemary Martino
    • 1
    • 4
    • 5
  1. 1.Department of Speech-Language Pathology, Faculty of MedicineUniversity of TorontoTorontoCanada
  2. 2.Radiation Medicine Program, Department of Radiation Oncology, Princess Margaret Cancer CentreUniversity Health Network, University of TorontoTorontoCanada
  3. 3.Division of Gastroenterology, Toronto Western HospitalUniversity Health NetworkTorontoCanada
  4. 4.Department of Otolaryngology—Head and Neck SurgeryUniversity of TorontoTorontoCanada
  5. 5.Health Care and Outcomes Research, Toronto Western Research InstituteUniversity Health NetworkTorontoCanada

Personalised recommendations