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The Impact of Proactive Gastrostomy Tube Placement on Treatment-related Outcomes in Young Children With High-grade

Chelsea Kotch1,2, Caitlin W Elgarten1,2, Jessica McWhorter1

  • 1Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia.

Journal of Pediatric Hematology/Oncology
|June 14, 2023
PubMed

Insights

Proactive gastrostomy tube (GT) placement may modestly reduce weight loss in young children with central nervous system (CNS) tumors during chemotherapy. However, benefits for hospitalization and nutrition support were not significant compared to nasogastric tubes (NGT).

Area of Science:

  • Pediatric Oncology
  • Clinical Nutrition
  • Medical Devices

Background:

  • Young children with high-grade central nervous system (CNS) tumors face malnutrition risks during intensive chemotherapy.
  • Existing guidelines for enteral tube placement in this population are lacking.
  • Previous research on proactive gastrostomy tube (GT) placement focused on limited outcomes like weight.

Purpose of the Study:

  • To evaluate the comprehensive impact of proactive gastrostomy tube (GT) placement on treatment outcomes in young children with high-grade CNS tumors.
  • To compare outcomes between proactive GT, rescue GT, and nasogastric tube (NGT) cohorts.

Main Methods:

  • Single-center, retrospective study of children under 60 months with high-grade CNS tumors.
  • Patients treated between 2015 and 2022 per CCG99703 or ACNS0334 protocols.
  • Analysis of outcomes including weight loss, antibiotic use, parenteral nutrition, and hospitalization duration.

Main Results:

  • Proactive GT placement was associated with less clinically significant weight loss during induction (22%) compared to NGT (47%), though not statistically significant (P=0.274).
  • No significant differences were observed between cohorts in antibiotic or parenteral nutrition utilization, weight loss at therapy completion, or hospitalization duration.
  • A total of 26 patients were included: 9 (35%) proactive GT, 8 (30%) rescue GT, and 9 (35%) NGT.

Conclusions:

  • Proactive gastrostomy tube (GT) placement shows modest effectiveness in preventing significant weight loss during the induction phase of chemotherapy for young children with CNS tumors.
  • There was no clear benefit of proactive GT over nasogastric tube (NGT) regarding hospitalization duration, antibiotic requirements, or parenteral nutrition needs.
  • An individualized approach to gastrostomy tube (GT) placement is recommended for pediatric patients with CNS malignancies receiving intensive chemotherapy.

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