Table 2.

Summary of studies comparing outcomes in patients undergoing head and neck cancer treatment – nasogastric versus percutaneous

Study	Year	Patient number	Study design	Measures	Findings
Corry et al.37	2008	33, PEG n = 15, NGT n = 18	Randomised trial to compare PEG and NGT in terms of nutritional outcomes, complications, patient satisfaction and cost	Baseline weight, weight loss, upper arm circumference and triceps skin fold thickness at time of tube insertion and 6 weeks post completion of treatment, duration of feeding tube use, dysphagia, quality of life (QOL) assessment	Six weeks post treatment no difference between NGT and PEG groups in terms of absolute weight or upper arm circumference, median weight loss 3 kg NGT versus 1.25 kg PEG (P = 0.001), NGT lower triceps skin fold thickness 9.5 versus 13.5 mm PEG (P = 0.03) suggesting loss of fat rather than muscle in NGT group; nil significant difference in weight loss at 6 months post insertion −2.1 kg NGT versus −0.9 kg PEG (P = 0.43); duration of tube feeding significantly longer in PEG group 139 days compared with 66 days NGT (P = 0.0006), nil significant difference in grade 3 dysphagia at 6 months; patient satisfaction with PEG greater than NGT in terms of convenience (P = 0.03), body image (P = 0.05), but nil difference in overall QOL (P = 0.89)
Sadasivan et al.38	2012	100, PEG n = 50, NGT n = 50	Prospective, randomised control study to compare the efficacy of PEG and NGT administration of EN in HNC patients undergoing curative treatment	Nutritional assessment including haemoglobin, weight, albumin, mid‐arm circumference at baseline and 6 weeks post insertion; complication rates (infection and tube dislodgement); patient satisfaction at 6 weeks post‐insertion of tube	Lower mean weight in PEG group 56.5 kg versus NGT 61 kg (P < 0.01); PEG group fared better in all nutritional parameters except serum albumin at 6 week (P < 0.001 all values); tube dislodgement 36% NGT and 0% PEG (P < 0.001), local site infection 64% NGT and 4% PEG (P < 0.001); modified QOL assessment at 6 weeks post tube insertion PEG showed statistically significant advantage in all aspects (P < 0.01 all variables)
Mekhail et al.39	2001	158, PEG n = 62, NGT n = 29	Retrospective review examining patterns of feeding tube use, incidence of mucositis and dysphagia, duration of tube dependence and need for pharyngo‐oesophageal dilatation between patients with PEG versus NGT during treatment of head and neck cancer with radiotherapy +/− chemotherapy	Degree of mucositis and dysphagia at baseline, 1, 3, 6 and 12 months after start of treatment; need for pharyngo‐oesophageal dilation; duration of tube use	Significant dysphagia more persistent among PEG versus NGT at 3 months (59% vs. 30%, P = 0.015), 6 months (30% vs. 8%, P = 0.029), but difference resolved by 12 months; median feeding tube duration 28 weeks PEG versus 8 weeks NGT P < 0.001; pharyngo‐oesophageal dilation required in 23% PEG patients versus 4% NGT (P = 0.022), 20% patients treated with chemoradiotherapy versus 0% patients treated with radiotherapy alone (P = 0.05)
Chang et al.40	2009	71, PEG n = 7, control n = 64	Retrospective review examining outcomes in patients undergoing radical radiotherapy for head and neck cancer with prophylactic PEG versus those managed reactively	Absolute weight loss; percentage weight loss; admission for nutrition related factors; treatment interruption	Mean weight loss PEG 1.6 kg, control 4.4 kg (P = 0.10); mean percentage weight loss PEG 4.0%, control 7.1% (P = 0.069; linear regression adjusting for risk factors P = 0.016); odds ratio admission for nutritional reasons for PEG versus control 0.43 (P = 0.33); 14% PEG versus 16% control required treatment interruption; 44% control group required NGT placement during treatment
Assenat et al.41	2011	139, PEG n = 61, control n = 78	Retrospective review to compare nutritional status and treatment interruption because of acute toxicity in patients with advanced head and neck tumours treated with combined chemoradiotherapy with or without prophylactic PEG tube	Weight loss and Nutritional Risk Index at beginning and end of treatment, interruption of treatment for toxicity and duration of interruption	Poorer nutritional status in PEG group at baseline (P < 0.0001); poorer nutritional status in control group post‐treatment with median weight loss −5 kg versus −1 kg PEG (P < 0.001); 57% control group required parenteral nutrition via central venous catheter with 7/45 patients developing CVC infection; incidence of treatment interruption, duration of interruption significantly lower in PEG group (P = 0.01 and P = 0.003, respectively)
Clavel et al.28	2011	253, NGT n = 126, control n = 127	Retrospective review of safety and efficacy of reactive use of NGT feeding only when required in patients undergoing combined chemoradiotherapy	Weight loss, hospitalisations, complications, duration of tube use, disease‐free survival and overall survival at 3 years	Median duration of NGT feeding 40 days; nil serious complications reported; nil significant difference in DFS or OS between NGT and control (83.7% vs. 82.0%, P = 0.948); median 33 month follow‐up with 3.6% patients requiring gastrostomy and 0.8% requiring pharyngo‐oesophageal dilatation

PEG, percutaneous endoscopic gastrostomy; NGT, nasogastric tube; CVC, central venous catheter; DFS, disease‐free survival; OS, overall survival.