ESTRO 2022

Session Item

Head and neck

Session Type: Poster (digital)

Track: Clinical

Journey:

Early NGT insertion prevents weight loss & treatment breaks in post-op CTRT and QoL assessment.

ajay gv, India

Presentation Number: PO-1101

Abstract

Abstract Title:

Early NGT insertion prevents weight loss & treatment breaks in post-op CTRT and QoL assessment.

Authors:

ajay gv¹, Ajay Choubey², Sambit Nanda³, Ashutosh Mukherji⁴, Sathyajit Pradhan⁵, Akhil Kapoor⁶, Aseem Mishra⁷, Dhanush S⁸, Ashalatha Devalla⁹

¹Mahamana Pandit Madan Mohan Malviya Cancer Centre, Radiation Oncology , Varanasi, India; ²Mahamana Pandit Madan Mohan Malviya Cancer Centre, Radiation Oncology , Varanasi, India; ³Mahamana Pandit Madan Mohan Malviya Cancer Centre, Radiation Oncology, Varanasi, India; ⁴Mahamana Pandit Madan Mohan Malviya Cancer Centre, Radiation onolcogy, Varanasi, India; ⁵Mahamana Pandit Madan Mohan Malviya Cancer Centre, Radiation Onoclogy, Varanasi, India; ⁶Mahamana Pandit Madan Mohan Malviya Cancer Centre, Medical Oncology, Varanasi, India; ⁷Mahamana Pandit Madan Mohan Malviya Cancer Centre, Head and Neck onoclogy, Varanasi, India; ⁸Mahamana Pandit Madan Mohan Malviya Cancer Centre, Speech and Swallowing dept, Varanasi, India; ⁹Kidwai Memorial Institute of Oncology, Radiation onology, bangalore, India

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Purpose or Objective

The standard of treatment in Post-operative head and neck ca is adjuvant RT or chemoradiation. Management of nutrition in these pts becomes prime importance due to acute reactions, weight loss leading to treatment breaks, and hospitalization. Early counseling and insertion of Nasogastric tube(NGT) in post-op chemoradiotherapy post(POCTRT) patients help in minimizing the treatment gap and weight loss during POCTRT.

This study was a retrospective audit from 2019 to 2020 for all POCTRT patients and the timing of the use of NGT and its effect on weight loss and treatment breaks during POCTRT.

Material and Methods

A total of 92 patients were given POCTRT between Jan 2019 and Aug 2020 who were audited for the timing of NGT insertion, weight loss, and treatment gap during the treatment. The total dose of POCTRT to a total dose of 60Gy/30#/ 5-6 weeks. Informed consent was taken from each patient and the EORTC QLQ-C30 questionnaire and QLQ-H&N35 module were used for assessing the QOL. All patients were treated with the Rapid arc technique. Global health status(GHS), Functional scale (FS), and Symptom scale(SS) values were assessed for various parameters. A general linear model multivariate analysis of variance was used to analyze the prognosticators of HR-QoL.

Results

The mean age at the time of diagnosis was 50±9yrs and the male to female ratio was 2:1 in the study population. The study population had a mean global health status (GHS) for overall QOL of 55.5 ± 13.4. All 92 patients completed the treatment and 1 patient died after treatment due to aspiration, was noted. The GHS, FS, and SS score at the start of treatment were 54.2±12.1, 86.0±6.2, 10.0±8.01, at the end of treatment was 50.8±9.6, 82.0±5.5, 12.4±6.6 and 4 months after treatment was 58.4±4.6, 88.9±4.8, 8.3±3.6 respectively. Gender and age did not contribute significantly. The QOL studies also showed that the symptoms gradually improved with treatment.

Out of 92 Patients who were treated with chemoradiation, 59 patients need NGT insertion, and 33 patients completed chemoradiation without NGT insertion. Significant weight loss(more than 5% of baseline weight) was found in 22% of patients in whom NGT insertion was done as against 43% who refused NGT insertion. NGT insertion was most commonly done at 2-3 weeks of treatment.

Conclusion

Early insertion of ryles tube by 2 nd week of POCTRT improves both QOL and decreases weight loss. Hence prophylactic NGT insertion may be recommended if the patients agree to NGT insertion in the early part of the treatment.

Compromised HRQOL and functional deficits among patients with POCTRT before the start of treatment, was observed in this study. The adoption of a QOL assessment as a standard procedure in hospital settings can contribute to anticipating interventions aimed at reducing the impact of therapeutic applications and improve subsequent patient management.