Impact of prophylactic gastrostomy or reactive NG tube upon patient-reported long term swallow function following chemoradiotherapy for oropharyngeal carcinoma: A matched pair analysis

•Influence of prophylactic gastrostomy on long term swallow outcomes is uncertain.•Study of patient-reported long term swallow outcomes following chemoradiotherapy.•Matched pair analysis used to assess influence of route of enteral feed.•Reactive nasogastric feed associated with superior long term swallow outcomes.

SummaryObjectivesThe purpose of this matched pair analysis is to assess patient-reported long term swallow function following chemoradiotherapy for locally advanced oropharyngeal cancer in relation to the use of a prophylactic gastrostomy or reactive nasogastric (NG) tube.Materials and methodsThe MD Anderson Dysphagia Inventory (MDADI) was posted to 68 consecutive patients with stage III/IV oropharyngeal squamous cell carcinoma who had completed parotid sparing intensity modulated radiotherapy with concurrent chemotherapy between 2010 and 2012, had not required therapeutic enteral feeding prior to treatment, minimum 2 years follow up post treatment, and who were disease free. 59/68 replies were received, and a matched pair analysis (matching for T and N stage) was performed for 52 patients, 26 managed with a prophylactic gastrostomy and 26 with an approach of an NG tube as needed.ResultsThere were no significant differences in patient demographics, pre-treatment diet and treatment factors between the two groups. Patient-reported swallowing function measured using the MDADI was superior for patients managed with an NG tube as required compared with a prophylactic gastrostomy: overall composite score 68.1 versus 59.4 (p = 0.04), global score 67.7 versus 60 (p = 0.04), emotional subscale 73.5 versus 60.4 (p < 0.01), functional subscale 75.4 versus 61.7 (p < 0.01), and physical subscale 59.6 versus 57.1 (p = 0.38).ConclusionsCompared with an approach of an NG tube as required, the use of a prophylactic gastrostomy was associated with inferior long term patient-reported long term swallow outcomes.