Volume 35, Issue 11 pp. 1634-1640

Original Article

Gastrostomy tube placement in patients with oropharyngeal carcinoma treated with radiotherapy or chemoradiotherapy: Factors affecting placement and dependence

Mihir K. Bhayani MD,

Mihir K. Bhayani MD

Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas

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Katherine A. Hutcheson PhD,

Katherine A. Hutcheson PhD

Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas

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Denise A. Barringer MS,

Denise A. Barringer MS

Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas

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Asher Lisec BS,

Asher Lisec BS

Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas

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Clare P. Alvarez MS,

Clare P. Alvarez MS

Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas

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Dianna B. Roberts PhD,

Dianna B. Roberts PhD

Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas

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Stephen Y. Lai MD, PhD,

Corresponding Author

Stephen Y. Lai MD, PhD

Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas

Stephen Y. Lai and Jan S. Lewin contributed equally to this work.

Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1445, Houston TX 77030. E-mail: [email protected] [email protected]Search for more papers by this author

Jan S. Lewin PhD,

Corresponding Author

Jan S. Lewin PhD

Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas

Stephen Y. Lai and Jan S. Lewin contributed equally to this work.

Mihir K. Bhayani MD,

Mihir K. Bhayani MD

Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas

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Katherine A. Hutcheson PhD,

Katherine A. Hutcheson PhD

Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas

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Denise A. Barringer MS,

Denise A. Barringer MS

Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas

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Asher Lisec BS,

Asher Lisec BS

Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas

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Clare P. Alvarez MS,

Clare P. Alvarez MS

Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas

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Dianna B. Roberts PhD,

Dianna B. Roberts PhD

Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas

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Stephen Y. Lai MD, PhD,

Corresponding Author

Stephen Y. Lai MD, PhD

Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas

Stephen Y. Lai and Jan S. Lewin contributed equally to this work.

Jan S. Lewin PhD,

Corresponding Author

Jan S. Lewin PhD

Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas

Stephen Y. Lai and Jan S. Lewin contributed equally to this work.

First published: 16 January 2013

https://doi.org/10.1002/hed.23200

Citations: 90

Ehab Y. Hanna, MD, was recused from consideration of this manuscript.

This work was presented at the ASTRO Annual Meeting, Miami, Florida, October 2011.

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Abstract

Background

Although many patients require nutritional support during radiotherapy or chemoradiotherapy for oropharyngeal cancer, little is known regarding the risk factors that predispose to gastrostomy tube (g-tube) placement and prolonged dependence, or the therapeutic interventions that may abrogate these effects.

Methods

We performed a retrospective medical chart review of patients who were treated for primary oropharyngeal cancer at a tertiary care center from 2003 to 2008. Patients who had a complete response at the primary site at 1-year posttreatment were included. G-tube placement and dependence ≥6 months were evaluated in relationship to site and stage of primary tumor, baseline characteristics, treatment type, smoking status, and swallowing intervention.

Results

We evaluated 474 patients (79%) with oropharyngeal cancer; 215 patients (40%) had concurrent chemotherapy, 73 patients (15%) had induction chemotherapy, and 69 patients (15%) had induction chemotherapy followed by concurrent chemotherapy. Two hundred ninety-three patients (62%) received g-tubes, of which 238 (81%) received the g-tube during radiation. At 1-year follow-up, 41 patients (9%) remained dependent on enteral feedings. Placement of g-tubes and prolonged g-tube dependence were significantly more likely in patients with T3 to 4 tumors (p < .001), baseline self-reported dysphagia (p < .001), odynophagia (p < .001), >10% baseline weight loss (p < .001), and in those treated with concurrent chemoradiotherapy. Patients who reported adherence to exercises had significantly lower rates of g-tube placement (p < .001), and duration of dependence was significantly shorter in those who reported adherence to swallowing exercises (p < .001).

Conclusion

Almost 40% of patients with oropharyngeal cancer treated with nonsurgical organ preservation modalities may avoid feeding tube placement. Factors that predispose to g-tube placement and prolonged dependence include T3 to T4 tumors, concurrent chemotherapy, current smoking status, and baseline swallowing dysfunction or weight loss. Adherence to an aggressive swallowing regimen may reduce long-term dependence on enteral nutrition and limit the rate of g-tube placement overall. © 2013 Wiley Periodicals, Inc. Head Neck, 35: 1634–1640, 2013

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Volume35, Issue11

November 2013

Pages 1634-1640

Gastrostomy tube placement in patients with oropharyngeal carcinoma treated with radiotherapy or chemoradiotherapy: Factors affecting placement and dependence

Abstract

Background

Methods

Results

Conclusion

REFERENCES

Citing Literature

References

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Gastrostomy tube placement in patients with oropharyngeal carcinoma treated with radiotherapy or chemoradiotherapy: Factors affecting placement and dependence

Abstract

Background

Methods

Results

Conclusion

REFERENCES

Citing Literature

References

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