{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T02:58:11Z","timestamp":1789095491971,"version":"build-2803163510"},"reference-count":31,"publisher":"Wiley","issue":"14","license":[{"start":{"date-parts":[[2023,6,16]],"date-time":"2023-06-16T00:00:00Z","timestamp":1686873600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>We launched a single\u2010arm phase II study to determine the efficacy and cost\u2010effectiveness of percutaneous endoscopic gastrostomy (PEG) before concurrent chemoradiotherapy (CCRT) in patients with esophageal squamous cell carcinoma (ESCC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Eligible patients received pretreatment PEG and enteral nutrition during CCRT. The primary outcome was the change of weight during CCRT. The secondary outcome included nutrition status, loco\u2010regional objective response rate (ORR), loco\u2010regional progression\u2010free survival (LRFS), overall survival (OS), and toxicities. A 3\u2010state Markov model was applied for cost\u2010effectiveness analysis. Eligible patients were matched and compared with those who had nasogastric tube feeding (NTF) or oral nutritional supplements (ONS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Sixty\u2010three eligible patients received pretreatment PEG\u2010based CCRT. The mean change of weight during CCRT was \u22121.4% (standard deviation, 4.4%), and after CCRT, 28.6% of patients gained weight and 98.4% had normal albumin levels. The loco\u2010regional ORR and 1\u2010year LRFS were 98.4% and 88.3%. The incidence of grade\u2009\u22653 esophagitis was 14.3%. After matching, another 63 patients were included in the NTF group and 63 in the ONS group. More patients gained weight after CCRT in the PEG group (<jats:italic>p<\/jats:italic>\u2009=\u20090.001). The PEG group showed higher loco\u2010regional ORR (<jats:italic>p<\/jats:italic>\u2009=\u20090.036) and longer 1\u2010year LRFS (<jats:italic>p<\/jats:italic>\u2009=\u20090.030). In cost analysis, the PEG group showed an incremental cost\u2010effectiveness ratio of $3457.65 per quality\u2010adjusted life\u2010years (QALY) compared with the ONS group with a probability of cost\u2010effectiveness of 77.7% at the $10,000 per QALY willingness\u2010to\u2010pay threshold.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Pretreatment PEG is associated with better nutritional status and treatment outcome in ESCC patients treated with CCRT compared with ONS and NTF. Pretreatment of PEG can be cost\u2010effective because of its significant clinical benefits.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.6136","type":"journal-article","created":{"date-parts":[[2023,6,16]],"date-time":"2023-06-16T13:01:59Z","timestamp":1686920519000},"page":"15000-15010","source":"Crossref","is-referenced-by-count":7,"title":["Efficacy and cost\u2010effectiveness analysis of pretreatment percutaneous endoscopic gastrostomy in unresectable locally advanced esophageal cancer patients treated with concurrent chemoradiotherapy (<scp>GASTO<\/scp> 1059)"],"prefix":"10.1002","volume":"12","author":[{"given":"XinLei","family":"Ai","sequence":"first","affiliation":[{"name":"Department of Radiation Oncology Sun Yat\u2010sen University Cancer Center  Guangzhou P.R. China"},{"name":"State Key Laboratory of Oncology in South China Sun Yat\u2010sen University Cancer Center  Guangzhou P.R. 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