{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:06:25Z","timestamp":1789707985021,"version":"4.0.1"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with head and neck cancer (HNC) undergoing chemoradiotherapy (CRT) are at high risk of malnutrition. The optimal timing of gastrostomy [percutaneous endoscopic gastrostomy (PEG) or radiologically inserted gastrostomy (RIG)] placement remains controversial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To compare survival, nutritional outcomes, and gastrostomy-related complications between prophylactic and later gastrostomy placement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective TriNetX US Collaborative Network cohort, prophylactic gastrostomy (within \u00b114\u202fdays of CRT initiation) was compared with early-reactive (15\u201390\u202fdays), late-reactive (91\u2013180\u202fdays), and very-late (&amp;gt;180\u202fdays) placement using 1:1 propensity-score matching on demographic, clinical, and laboratory characteristics. Survival was measured from index gastrostomy; therefore, comparisons with later placement were conditional on survival until gastrostomy and considered exploratory rather than estimates of the effect of placement timing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The prophylactic-versus-very-late comparison included 2,251 matched pairs, analyzed at 1\u20132 and 2\u20135\u202fyears. Post-gastrostomy survival was similar between prophylactic and early-reactive placement at both intervals [hazard ratio (HR) 0.94 and 0.95; both nonsignificant]. Compared with very-late placement, survival did not differ at 1\u20132\u202fyears (HR 0.90, 95% CI 0.65\u20131.25) but was higher at 2\u20135\u202fyears (88.4% vs. 83.2%; HR 0.69, 95% CI 0.48\u20130.98); adjusted HRs were 0.72 (0.54\u20130.96) and 0.61 (0.45\u20130.83), respectively. Survival was higher with prophylactic versus late-reactive placement at 1\u20132\u202fyears (84.2% vs. 77.8%; HR 0.70, 95% CI 0.54\u20130.90), but not at 2\u20135\u202fyears (HR 0.64, 95% CI 0.32\u20131.26). Prophylactic placement was associated with fewer gastrostomy-related complications than very-late placement (1.8% vs. 3.1% at 1\u20132\u202fyears; 1.3% vs. 2.6% at 2\u20135\u202fyears), less aspiration pneumonia at 1\u20132\u202fyears (1.0% vs. 1.9%), and higher serum albumin (3.89 vs. 3.70\u202fg\/dL; all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05), while malnutrition (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.10) and body mass index (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.45) did not differ.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Prophylactic and early-reactive placement had comparable post-gastrostomy survival, supporting early-reactive placement as a reasonable alternative in appropriately monitored patients. Poorer outcomes with late and very-late placement may identify a clinically higher-risk population rather than demonstrate a benefit of earlier placement. Prospective target-trial emulation studies are needed to define optimal timing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1885057","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:36:36Z","timestamp":1789706196000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Timing matters: gastrostomy placement and outcomes in patients with head and neck cancer undergoing chemoradiotherapy"],"prefix":"10.3389","volume":"13","author":[{"given":"Esther","family":"Forkosh","sequence":"first","affiliation":[{"name":"Hadassah Medical Center, Institute of Gastroenterology and Hepatology","place":["Jerusalem, Israel"]},{"name":"Institute of Gastroenterology and Hepatology, Hadassah Medical Center","place":["Jerusalem, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yousra","family":"Sharif","sequence":"additional","affiliation":[{"name":"Hadassah Medical Center, Institute of Gastroenterology and Hepatology","place":["Jerusalem, Israel"]},{"name":"Institute of Gastroenterology and Hepatology, Hadassah Medical Center","place":["Jerusalem, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Hakimian","sequence":"additional","affiliation":[{"name":"Hadassah Medical Center, Institute of Gastroenterology and Hepatology","place":["Jerusalem, Israel"]},{"name":"Institute of Gastroenterology and Hepatology, Hadassah Medical Center","place":["Jerusalem, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1665019","DOI":"10.3389\/fonc.2025.1665019","article-title":"Global burden of head and neck cancer: 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