Predictors of Gastrostomy Placement and Dependence in Oropharyngeal Cancer Patients Treated with Chemoradiotherapy
Gady Har-El, Edward D McCoul, Krishnamurthi Sundaram
Citation Information :
Har-El G, McCoul ED, Sundaram K. Predictors of Gastrostomy Placement and Dependence in Oropharyngeal Cancer Patients Treated with Chemoradiotherapy. Int J Head Neck Surg 2010; 1 (2):79-85.
Treatment of oropharyngeal cancer (OPC) with primary chemoradiotherapy (CRT) may necessitate placement of a gastrostomy tube (GT). We sought to identify factors that may predict GT placement and dependence.
Materials and methods
A retrospective review of 61 consecutive patients receiving primary CRT for OPC over a 10-year period at a tertiary referral center. Patients with prior head and neck malignancy, distant metastasis, incomplete treatment course, or inadequate follow-up were excluded. Forty-four patients were included for analysis.
Results
Sixty-one percent of tumors were located in the tonsil and 62% were stage IV disease at presentation. Complete response to CRT occurred in 36 patients, among whom GT placement was more likely when weight loss occurred before the start of CRT than after CRT (p = 0.028). Continued GT dependence was more likely in patients with GT placement after the start of CRT (p = 0.019). Multivariate analysis showed significant associations of GT placement with post-treatment dysphagia and mucositis. Advanced tumor stage was a significant predictor of GT dependence.
Conclusions
Prophylactic GT placement may be advisable in patients receiving CRT for OPC who have pretreatment weight loss. Conversely, GT may be withheld from asymptomatic patients.
Patients experience with long-term percutaneous endoscopic gastrostomy feeding following primary surgery for oral and oropharyngeal cancer. Oral Oncol 2007;43:499-507.
Perioperative enteral nutrition and quality of life of severely malnourished head and neck cancer patients: A randomized clinical trial. Clin Nutr 2000;19:437-44.
Swallow function in patients before and after intra-arterial chemoradiation. Laryngoscope 2003;113:573-79.
Score system for elective tracheotomy in major head and neck tumour surgery. Acta Anaesthesiol Scan 2005;49:654-59.
Organ preservation therapy using induction plus concurrent chemoradiation for advanced resectable oropharyngeal carcinoma: A University of Pennsylvania Phase II trial. J Clin Oncol 2002;20:3964-71.
Swallowing and speech ability after treatment for head and neck cancer with targeted intraarterial versus intravenous chemoradiation. Head Neck 2002;24:68-77.
Concomitant radiation therapy and targeted cisplatin chemotherapy for the treatment of advanced pyriform sinus carcinoma: Disease control and preservation of organ function. Head Neck 1999;21:595-601.
Swallowing function after chemoradiation for advanced stage oropharyngeal cancer. Otolaryngol Head Neck Surg 2006;134:455-59.
Nutritional and metabolic assessment of the hospitalized patient. JPEN J Parenter Enteral Nutr 1977;1:11-22.
Statistical power analysis for the behavioral sciences. Second edeition. Hillsdale, New Jersey: Lawrence Erlbaum, 1988.
Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med 1998;338:1798-804.
Preoperative induction chemotherapy followed by concurrent chemoradiotherapy in advanced carcinoma of the oral cavity and oropharynx. Cancer 2000;89:939-45.
Maximizing local control and organ preservation in stage IV squamous cell head and neck cancer with hyperfractionated radiation and concurrent chemotherapy. J Clin Oncol 2002;20:1405-10.
Swallowing function and tracheotomy dependence after combined-modality treatment including free tissue transfer for advanced-stage oropharyngeal cancer. Laryngoscope 2003;113:1294-98.
Critical weight loss in head and neck cancer; prevalence and risk factors at diagnosis: an explorative study. Supportive care in cancer 2007;15:1045-50.
Incidence of weight loss in head and neck cancer patients on commencing radiotherapy treatment at a regional oncology centre. European J Cancer Care 2001;8:133-36.
Prognostic factors in advanced head and neck cancer patients undergoing multimodality therapy. Otolaryngol Head Neck Surg 1991;105:62-73.
Prophylactic gastrostomy tubes in patients undergoing intensive irradiation for cancer of the head and neck. Arch Otolaryngol Head Neck Surg 1998;124:871-75.
Nutritional consequences of the radiotherapy of head and neck cancer. Cancer 1983;51:811-15.