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Multimodality radical surgery, chemotherapy and radiation therapy in varying order of exposure have advanced the treatment of head & neck cancer (HNC).These advances have improved outcomes but sometimes cause additional co-morbidity from oro-pharyngeal-mucocutaneous injury leading to malnutrition.The prophylactic placement of a percutaneous endoscopic gastrostomy (PEG) tubeis performedto correct or prevent nutritional deficits, maintain hydration and improve quality of life.However, translocation of tumor cells from the HNC to the gastrostomy site has been described in various case reports.The Nutritional Support Service at H.Lee Moffitt Cancer Center and Research Institute maintains a database of prospectively collected data on all patients receiving nutrition support.A retrospective review of this data base identified all patients with head and neck cancer who underwent PEG tube placement from January 1985 to September 2002.The patient was considered to have active disease if he or she had not received any treatment before PEG insertion, had positive margins after surgical resection or had a visible lesion at the time of PEG placement.After 2002, patients who possessed these parameters of tumor activity underwent gastrostomy tube placement using radiographic or Russell tube placement.Subsequent analysis was made for the development of PEG site metastases From 1985-2002 atotal of 304 patients underwent PEG placement for HNC (221 men and 83 women);the mean age was 62 years (range 27-96 years).The pull through technique was performed in 98% of cases using commercially available gastrostomy kits, the other gastrostomy tubes were placed with the Russell technique.The tumor location in the active disease group included 6 neck, 10 sinal, 11 palatal, 26 pharyngeal,28 laryngeal, 28 nasopharyngeal, 32 tonsil, and 67 tongue cancers.141 PEG tubes were placed at the time of treatment for primary disease and 65 were placed at the time of recurrence.The tumor stage of all patients with active disease was T2Nlor greater.Of 304 patients who received PEG tube during treatment for HNC, 208 had active disease at the time of placement.Two patients with active disease developed abdominal wall metastases (0.92%).None of the patients with inactive disease (0 of 86) or tumor in the oro-pharynx developed metastases to the PEG site.After2005 nutrition support of HNC patients with active disease underwent radiographically or introducer technique gastrostomy tubes.The small risk of tumor implantation to the PEG site in active HNC tumor patients can be ameliorated by avoiding a placement technique that draws the tube in contact with the HNC.