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Table 1 Questions of the survey

From: Prophylactic gastrostomy in locally advanced head and neck cancer: results of a national survey among radiation oncologists

1. Speciality
2. Instutution
3. Is the indication for prophylactic gastrostomy discussed at the multidisciplinary board? Yes/No
4. How many patients do you irradiate per year in your center 0/0–20/21–50/51–100/> 100
5. In case of a Locally Advanced Head and Neck Cancer (LAHNC) patient, without dysphagia nor contraindications for gastrostomy, with normal nutritional status who will undergo chemo-radiation, to which degree the following factors would influence your decision: a) the foreseen irradiated volume of oral/oropharyngeal mucosa, constrictor muscles and oesophagus?; b) the anatomical site of the tumour?; c) the postoperative versus curative setting?; d) the patient’s choice?; e) the expertise of your centre in gastrostomy placement? Not at all important/Slightly Important/Important/Fairly Important/Very Important
6. In your centre which technique is used to place gastrostomies (you can select more than one if necessary) Endoscopic/Radiologic/Laparoscopic/Gastrostomies are not used/Other
7. When do you start enteral nutrition via prophylactic gastrostomy? Immediately following the prophylactic gastrostomy placement/from the start of radiotherapy/Later, when clinically indicated/Other (free text)
8. When do you remove the prophylactic gastrostomy? At the end of chemo-radiation/When the patient is able to assume an adequate oral feeding/In case of complete locoregional remission at the first evaluation post chemo-radiation/Other, please specify (free text)
9. In your opinion, could the use of a prophylactic gastrostomy have a negative impact on swallowing function after chemo-radiation? Yes/No/No opinion