Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Nutrition and Health (including climate and ecological aspects)

Effect of prophylactic gastrostomy on nutritional and clinical outcomes in patients with head and neck cancer



We aimed to identify which enteral feeding method was most beneficial for patients and compare clinical outcomes, quality of life, and complication rates by assessing patients who underwent prophylactic percutaneous endoscopic gastrostomy (pPEG) tube, reactive percutaneous endoscopic gastrostomy (rPEG) tube or reactive nasogastric tube (rNGT) insertion.


Patients with head and neck cancers (HNCs) were enrolled between April 1, 2013 and April 17, 2019 (n = 335; 296 males, 39 females). Data concerning patient characteristics and treatment modalities were extracted from the medical records. Comparisons between enteral feeding methods were made by univariate and multivariate analysis. Overall survival (OS) outcomes were analyzed by the log rank test using the Kaplan–Meier method.


A total of 335 patients were included. The median follow-up time was 29.5 months. There were forty-six patients in the pPEG tube group, 23 patients in the rPEG tube group, and 266 patients in the rNGT group. pPEG, increased body-mass index (BMI), and N0-1 category were significantly associated with less weight loss in the multivariate analysis (all P < 0.05). pPEG decreased the rate of radiotherapy delay compared with that of reactive interventions (23.1% vs. 47.1%, P = 0.007). In terms of quality of life, global health status, role functioning, emotional functioning, cognitive functioning, pain, and dyspnea were significantly improved in the pPEG tube group (all P < 0.05). BMI and weight loss were independent prognostic factors for clinical survival outcomes (all P < 0.05).


pPEG could improve nutrition outcomes, reduce treatment delay, and maintain quality of life.

Your institute does not have access to this article

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Fig. 1: Overall survival curves separated by weight loss ≥ 2% and weight loss < 2% group.
Fig. 2: Overall survival curves of patients with or without BMI gain.

Data availability

Data sharing requests for data will be dealt with by the corresponding author after the study has been published. Subject to approval by the corresponding author and Sun Yat-sen University Cancer Center, de-identified participant data will be available. To evaluate whether a data request is reasonable, a detailed research protocol will be required. Depending on the materials provided by researchers, the corresponding author and Sun Yat-sen University Cancer Centre reserve the right to decide whether to share the data or not.


  1. McCarter K, Baker AL, Britton B, Beck AK, Carter G, Bauer J, et al. Effectiveness of clinical practice change strategies in improving dietitian care for head and neck cancer patients according to evidence-based clinical guidelines: a stepped-wedge, randomized controlled trial. Transl Behav Med. 2018;8:166–74.

    Article  Google Scholar 

  2. Salas S, Baumstarck-Barrau K, Alfonsi M, Digue L, Bagarry D, Feham N, et al. Impact of the prophylactic gastrostomy for unresectable squamous cell head and neck carcinomas treated with radio-chemotherapy on quality of life: Prospective randomized trial. Radiother Oncol. 2009;93:503–9.

    Article  Google Scholar 

  3. Denis F, Garaud P, Bardet E, Alfonsi M, Sire C, Germain T, et al. Final results of the 94-01 French Head and Neck Oncology and Radiotherapy Group randomized trial comparing radiotherapy alone with concomitant radiochemotherapy in advanced-stage oropharynx carcinoma. J Clin Oncol. 2004;22:69–76.

    Article  Google Scholar 

  4. Assenat E, Thezenas S, Flori N, Pere-Charlier N, Garrel R, Serre A, et al. Prophylactic percutaneous endoscopic gastrostomy in patients with advanced head and neck tumors treated by combined chemoradiotherapy. J Pain Symptom Manag. 2011;42:548–56.

    Article  Google Scholar 

  5. Trotti A, Bellm LA, Epstein JB, Frame D, Fuchs HJ, Gwede CK, 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. Radiother Oncol. 2003;66:253–62.

    Article  Google Scholar 

  6. McClelland S, Andrews JZ, Chaudhry H, Teckie S, Goenka A. Prophylactic versus reactive gastrostomy tube placement in advanced head and neck cancer treated with definitive chemoradiotherapy: A systematic review. Oral Oncol. 2018;87:77–81.

    Article  Google Scholar 

  7. Pajak TF, Laramore GE, Marcial VA, Fazekas JT, Cooper J, Rubin P, et al. Elapsed treatment days-a critical item for radiotherapy quality control review in head and neck trials: RTOG report. Int J Radiat Oncol Biol Phys. 1991;20:13–20.

    CAS  Article  Google Scholar 

  8. Lee JH, Machtay M, Unger LD, Weinstein GS, Weber RS, Chalian AA, et al. Prophylactic gastrostomy tubes in patients undergoing intensive irradiation for cancer of the head and neck. Arch Otolaryngol Head Neck Surg. 1998;124:871–5.

    CAS  Article  Google Scholar 

  9. 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;2013:CD007904.

  10. Paleri V, Patterson J. Use of gastrostomy in head and neck cancer: a systematic review to identify areas for future research. Clin Otolaryngol. 2010;35:177–89.

    CAS  Article  Google Scholar 

  11. 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 (R Coll Radio). 2010;22:192–8.

    CAS  Article  Google Scholar 

  12. Talwar B, Findlay M. When is the optimal time for placing a gastrostomy in patients undergoing treatment for head and neck cancer? Curr Opin Support Palliat Care. 2012;6:41–53.

    Article  Google Scholar 

  13. Bradley PT, Brown T, Paleri V. Gastrostomy in head and neck cancer: current literature, controversies and research. Curr Opin Otolaryngol Head Neck Surg. 2015;23:162–70.

    Article  Google Scholar 

  14. Rabinovitch R, Grant B, Berkey BA, Raben D, Ang KK, Fu KK, et al. Impact of nutrition support on treatment outcome in patients with locally advanced head and neck squamous cell cancer treated with definitive radiotherapy: a secondary analysis of RTOG trial 90-03. Head Neck. 2006;28:287–96.

    Article  Google Scholar 

  15. Forastiere AA, Zhang Q, Weber RS, Maor MH, Goepfert H, Pajak TF, et al. Long-term results of RTOG 91-11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol: Off J Am Soc Clin Oncol. 2013;31:845–52.

    CAS  Article  Google Scholar 

  16. Cady J. Nutritional support during radiotherapy for head and neck cancer: the role of prophylactic feeding tube placement. Clin J Oncol Nurs. 2007;11:875–80.

    Article  Google Scholar 

  17. Locher JL, Bonner JA, Carroll WR, Caudell JJ, Allison JJ, Kilgore ML, et al. Patterns of prophylactic gastrostomy tube placement in head and neck cancer patients: a consideration of the significance of social support and practice variation. Laryngoscope. 2013;123:1918–25.

    Article  Google Scholar 

  18. Martín Villares C, San Román Carbajo J, Fernández Pello ME, Tapia Risueño M, Domínguez Calvo J. [Nutritional status in head and neck cancer patients: the impact on the prognoses]. Nutr Hosp. 2003;18:91–4.

    PubMed  Google Scholar 

  19. Kramer S, Newcomb M, Hessler J, Siddiqui F. Prophylactic versus reactive PEG tube placement in head and neck cancer. Otolaryngol Head Neck Surg. 2014;150:407–12.

    Article  Google Scholar 

  20. Lewis SL, Brody R, Touger-Decker R, Parrott JS, Epstein J. Feeding tube use in patients with head and neck cancer. Head Neck. 2014;36:1789–95.

    Article  Google Scholar 

  21. 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;34:1–9.

    Article  Google Scholar 

  22. 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;48:434–40.

    Article  Google Scholar 

  23. 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;21:3433–9.

    Article  Google Scholar 

  24. Blomberg J, Lagergren J, Martin L, Mattsson F, Lagergren P. Complications after percutaneous endoscopic gastrostomy in a prospective study. Scand J Gastroenterol. 2012;47:737–42.

    Article  Google Scholar 

  25. McAllister P, MacIver C, Wales C, McMahon J, Devine JC, McHattie G, et al. Gastrostomy insertion in head and neck cancer patients: a 3 year review of insertion method and complication rates. Br J Oral Maxillofac Surg. 2013;51:714–8.

    CAS  Article  Google Scholar 

  26. Ermis F, Ozel M, Oncu K, Yazgan Y, Demirturk L, Gurbuz AK, et al. Indications, complications and long-term follow-up of patients undergoing percutaneous endoscopic gastrostomy: a retrospective study. Wien Klin Wochenschr. 2012;124:148–53.

    Article  Google Scholar 

  27. van Bokhorst-de van der S, van Leeuwen PA, Kuik DJ, Klop WM, Sauerwein HP, Snow GB, et al. The impact of nutritional status on the prognoses of patients with advanced head and neck cancer. Cancer. 1999;86:519–27.

    Article  Google Scholar 

  28. Dewys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med. 1980;69:491–7.

    CAS  Article  Google Scholar 

  29. Lopez MJ, Robinson P, Madden T, Highbarger T. Nutritional support and prognosis in patients with head and neck cancer. J Surg Oncol. 1994;55:33–6.

    CAS  Article  Google Scholar 

  30. Brookes GB. Nutritional status-a prognostic indicator in head and neck cancer. Otolaryngol Head Neck Surg. 1985;93:69–74.

    CAS  Article  Google Scholar 

Download references


This study was funded by the Planned Science and Technology Project of Guangdong Province (No 2016A020215085, 201707010087) and the 308 Clinical Research Funding of Sun Yat-Sen University Cancer Center (No 308-2015-011).

Author information

Authors and Affiliations



Conceptualization, LC and L-XL; methodology, Q-QX; software, Q-QX and L-LG; validation, J-HL, LC and YW; formal analysis, L-LG, J-HL, LC; investigation, YW; resources, L-XL; data curation, LC; writing—original draft preparation, Q-QX; writing—review and editing, Q-QX and L-LG; visualization, Q-QX and LC; supervision, L-XL; project administration, LC and L-XL; funding acquisition, L-XL. All authors have read and agreed to the published version of the manuscript.

Corresponding authors

Correspondence to Lei Chen or Li-Xia Lu.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Xu, QQ., Guo, LL., Lou, JH. et al. Effect of prophylactic gastrostomy on nutritional and clinical outcomes in patients with head and neck cancer. Eur J Clin Nutr (2022).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI:


Quick links