Prophylactic vs reactive PEG tube placement in early-stage head and neck (H&N) cancer treated with curative-intent radiotherapy: Balancing benefit and burden in real-world practice.

12150 Background: Timing of Percutaneous Endoscopic Gastrostomy (PEG) placement during curative-intent radiotherapy for H&N cancer remains controversial. We compared 6-month and 1-year outcomes after prophylactic (pPEG) versus reactive (rPEG) PEG placement in real-world practice. Methods: We conducted a retrospective study using the TriNetX Network database. Adults (≥18 years) with H&N cancer treated with curative-intent radiotherapy who received PEG were stratified by PEG timing: pPEG (≤30 days before or at radiotherapy initiation) versus rPEG (30–90 days after radiotherapy initiation). The index date was PEG insertion. After 1:1 propensity-matching with demographics, comorbidities, nutrition/weight variables, BMI, stage, chemotherapy/surgery, 2,752 patients remained in each cohort. Outcomes at 6 months and 1 year were analyzed using Kaplan–Meier methods with log-rank tests and Cox proportional-hazards models (HR, 95% CI). Results: At 6 months, compared with rPEG, pPEG was associated with lower all-cause mortality, but higher hospitalization, sepsis, PEG tube dependence, and PEG tube complications. ICU admission, aspiration pneumonitis, pneumonia, and dehydration were similar between cohorts. At 1 year, all-cause mortality and ICU admission remained similar between groups. However, pPEG was associated with higher hospitalization, aspiration pneumonitis, pneumonia, sepsis, and PEG tube complications, while dehydration and PEG tube dependence were similar (see Table). pPEG was associated with higher risk of dysphagia at 6 months (HR 1.3, 95% CI 1.1–1.6; p<0.01) and 1 year (HR 1.2, 95% CI 1.1–1.5; p=0.01), and malnutrition at 6 months (HR 1.3, 95% CI 1.1–1.6; p<0.01) and 1 year (HR 1.3, 95% CI 1.1–1.6; p<0.01). Unintentional weight loss and PEG tube removal did not differ between groups. Conclusions: In this real-world cohort study, pPEG was not associated with improved 1-year survival and was associated with higher acute care utilization, infections, and PEG-related complications compared with rPEG. These findings support selective, risk-stratified pPEG use rather than routine prophylactic placement. Outcome 6 Month HR (95% CI, p-value) 1 Year HR (95% CI, p-value) All-cause mortality 0.8 (0.7-0.9, p=0.04) 0.9 (0.8-1.1, p=0.6) Hospitalization 1.3 (1.01-1.6, p=0.04) 1.2 (1.1-1.5, p=0.04) ICU admission 1.0 (0.8-1.3, p=0.6) 1.1 (0.9-1.3, p=0.3) Aspiration pneumonitis 1.2 (0.9-1.5, p=0.07) 1.2 (1.1-1.5, p=0.03) Pneumonia 1.2 (0.9-1.4, p=0.1) 1.2 (1.1-1.4, p=0.04) Sepsis 1.3 (1.01-1.5, p=0.03) 1.3 (1.1-1.5, p=0.01) Dehydration 1.6 (0.9-2.6, p=0.08) 1.5 (0.9-2.3, p=0.1) PEG tube dependence 1.2 (1.01-1.3, p=0.04) 1.1 (0.9-1.3, p=0.07) PEG tube complication 1.2 (1.1-1.4, p<0.01) 1.2 (1.1-1.3, p<0.01) HR > 1 indicates higher hazard in pPEG vs rPEG; HR < 1 indicates lower hazard.