[Nutrition of ENT tumor patients treated with radiotherapy. Comparison of oral and enteral nutrition using percutaneous gastrostomy].

The nutritional state of 99 patients with head and neck malignancies was assessed before, during and up to 18 weeks after radiotherapy (DXRT) using anthropometry, immunology and blood chemistry. 73 patients were fed orally during therapy, first with a normal diet and later, when the side effects of DXRT worsened, with a supplemental liquid formula diet. During the first two weeks 26 patients were treated with a PEG (percutaneous endoscopically controlled gastrostomy) and were fed mainly enterally with formula diets. The parameters of those patients fed orally during DXRT worsened rapidly and only recovered slowly and incompletely. On the contrary, in spite of their poor initial condition, the patients with PEG improved their state of nutrition, even during DXRT. Both the objective parameters of nutrition and the subjective condition of the patients were measured with the help of the "quality of life index". During DXRT the quality of life of both groups deteriorated equally. The objective parameters of nutrition showed that the patient's strength and the capacity for work remained constant. Unexpectedly, after DXRT only the orally fed patients were found to have an improved subjective condition, probably because the PEG patients were reminded of their disease by the tube, in spite of successful completion of tumor therapy. This undoubtedly impedes the return to normal family and working life. Early and consistent enteral diet with PEG helps to stabilize the state of nutrition of patients with head and neck cancer, and is recommended, especially for patients already suffering from malnutrition before starting an aggressive multimodal tumor therapy.