What is your criteria for a prophylactic PEG tube in patients initiating head and neck radiotherapy?

We do not routinely insert prophylactic tubes to patients receiving bilateral neck RT concurrent with chemo, unless they are malnourished to start with. The outcome is a need to insert feeding tubes to 25-33% of these pts due to sig wt loss during chemo-RT. Thus, most pts do not need PEG. continuing to eat/drink during chemoRT may reduce late dysphagia/strictures. In any case, we demand pts with PEG to continue oral feeding as much as possible.

This is an important and too mundane question for the great thinkers to study. In inner city Detroit, we tried to do PEG for all, and got perhaps 2/3rds PEGged -- greater barrier was dental extraction for non-viale teeth. Rest of state: optional. In Scranton, it has been uncommon. There is no question that those with PEG are "easier to manage", maintain weight and get through. Despite IMRT parotid sparing, dysfunctional saliva is the main problem, and aggressive oropharyngeal hygiene with hourly...

The answer to this Q is going to differ based on a number of factors, including the region and the hospital they are practicing at. There is little debate about the point that the swallowing mechanism is a "use it or loose it"! There is also an acceptance that a number of H&N patients (perhaps 1/3 to 1/2) would end up requiring a PEG for nutritional support, esp whose targets are closer to the pharyngeal inlet (vs. lateralized) + getting conc chemo. A lot depends on patient motivation to avoid a...

We use prophylactic PEGs in patients getting RT to bilateral neck with concurrent chemo. If a patient is getting RT to bilateral neck without chemo or is getting RT to ipsilateral neck only, then we do not get a PEG prophylactically.

We place prophylactic PEG tubes for patients in the following situations-

1. Significant weight loss at presentation of 10-20 lbs

2. Complete inability to swallow at presentation

3. Advanced hypopharyngeal cancers

4. Post patients with total glossectomy

For all other patients we follow a "PEG-on-demand" policy.

All our patients are assessed by SLPs and dieticians at initial evaluation and PEG placement, use and management is closely monitored. As mentioned by Dr Eisbruch, maintaining swallowing ...