Late Feeding Tube Dependency in Head and Neck Cancer Patients Treated with Definitive Radiation Therapy and Concurrent Systemic Therapy

Friedes, Cole; Klingensmith, Jessica; Nimo, Nana; Gregor, Jessica W.; Burri, Ryan J.

doi:10.7759/cureus.7683

Cited by 10 publications

(9 citation statements)

References 29 publications

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“…Our long‐term PEG‐dependent patients had primary tumours in the hypopharynx, and this finding is similar to previous studies which showed significantly increased risk of aspiration and dysphagia rates in this cohort of patients 27,28 . T classification ≥3 and level 2 lymphadenopathy may also assist in predicting requirements for prolonged feeding 29,30 . Although our study did not find any association, additional research is necessary to fully comprehend the relationship between T‐stage, N‐stage and PEG dependency or weight loss in HNC patients.…”

Section: Discussionsupporting

confidence: 89%

Routine Prophylactic Percutaneous Endoscopic Gastrostomy in Head and Neck Cancers with Bilateral Neck Irradiation: A Regional Cancer Experience in New Zealand

Fong

Pandey

Rajaretnam

et al. 2023

J of Medical Radiation Sci

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IntroductionPatients with head and neck cancer (HNC) are particularly susceptible to dysphagia and malnutrition. Prophylactic percutaneous endoscopic gastrostomy (PEG) placement is a method used to manage these issues, but practices vary among institutions. At Midcentral District Health Board, patients receiving radiotherapy to the primary and bilateral neck regions routinely undergo prophylactic PEG placement. This study aimed to review the nutritional and PEG‐related outcomes of these patients.MethodsRecords of 49 patients were retrospectively reviewed. Their demographics, tumour and treatment characteristics were recorded. We evaluated patient weight loss, non‐elective hospitalisation, treatment interruption rates, PEG‐related complications, usage, dependency rates and late dysphagia rates.ResultsOropharyngeal cancers were the most common primary site (61.2%), and 83.7% of patients received primary chemoradiotherapy. Mean weight loss at treatment completion was 5.6% ± 4.3 (4.6 kg ± 3.9). The rate of non‐elective hospitalisations was 26.5%, and only 2% of patients had treatment interruptions. Peristomal infection was the most frequent PEG complication (20.4%). No PEG‐related mortality was reported. Median duration of PEG dependency was 97 days (14–388 days). Two patients remained permanently dependent at 3 years due to grade 3 dysphagia, and six patients experienced grade ≥2 late dysphagia.ConclusionOur study showed that prophylactic PEG tube placement was relatively safe, with a high utilisation rate and low long‐term dependence on PEG tubes after treatment completion. However, complications related to their use should be addressed through a multidisciplinary approach, with careful assessment by clinicians. The weight loss and hospitalisation rates observed were consistent with earlier studies that utilised prophylactic PEG tubes.

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Section: Discussionsupporting

confidence: 89%

Routine Prophylactic Percutaneous Endoscopic Gastrostomy in Head and Neck Cancers with Bilateral Neck Irradiation: A Regional Cancer Experience in New Zealand

Fong

Pandey

Rajaretnam

et al. 2023

J of Medical Radiation Sci

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“…In accordance, we observed a negative effect of long-term PEG use on survival. Since our previous works showed that malnutrition negatively impacts survival in HNC patients [ 5 , 8 ], these results are consistent [ 5 , 21 ].…”

Section: Discussionsupporting

confidence: 86%

“…Doses to the swallowing structures, like the OAR larynx and pharyngeal constrictors, seem to be associated with long-term swallowing complications and/or long-term PEG tube dependence [ 1 – 4 ]. Long-term PEG tube need is linked to poorer overall survival in HNC patients [ 5 ]. According to Caudell et al., a mean dose (Dmean) to the larynx exceeding 41 Gy and a laryngeal volume of more than 24% receiving 60 Gy (V60Gy > 24%), as well as V60Gy > 12% to the inferior pharyngeal constrictor correlated with PEG tube dependence and aspiration.…”

Section: Introductionmentioning

confidence: 99%

Impact of dosimetric factors on long-term percutaneous enteral gastrostomy (PEG) tube dependence in head and neck cancer patients after (chemo)radiotherapy—results from a prospective randomized trial

et al. 2022

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Purpose/objective To analyze dose–volume histogram (DVH)-derived data on the exposure of organs at risk with impact on long-term percutaneous enteral gastrostomy (PEG) tube dependence in head and neck cancer patients at 6 and 12 months after definitive or adjuvant (chemo)radiotherapy. Materials and methods Sixty-one patients were prospectively treated with (chemo)radiotherapy. Prophylactic or reactive gastrostomy tube placement was performed in 41 (67.2%) patients. Dose–volume histogram parameters were obtained for the swallowing apparatus. Results Median follow-up time was 25 (2–34) months. Overall survival was shorter in patients with inlying PEG tubes at 6 and 12 months (log rank p = 0.038 and p = 0.017) after therapy completion. The estimated median time of tube dependency was 6 (95% confidence interval: 2–14) months. After 6 months, 46.5% of patients were tube dependent. After 12 months, this estimated proportion fell to 31.5%. For both time points, the volume to the larynx (in %) receiving at least 50 Gy (larynx V50Gy) exceeding 53% was predictive for long-term tube feeding (6 months: p = 0.041 and 12 months: p = 0.042) being an independent predictor during multivariable analysis. There was no clinical feature influencing tube dependence after 12 months. Conclusion Long-term gastrostomy dependence was found to be strongly associated with an exposure of laryngeal structures (specifically, V50Gy ≥ 53%) during radiotherapy. Consequently, the avoidance of supraglottic as well as glottic structures is warranted.

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“…It is well known that long‐term enteral tube dependence results in worse swallowing outcomes 33–35 . In a cohort of patients with late‐stage HNC definitively cured with chemoradiation, authors found that PEG dependency was significantly correlated with worse OS compared to those who were PEG‐independent 36 . Known predictors of PEG tube placement include advanced patient age, advanced disease, smoking status, and primary tumor site 37 .…”

Section: Discussionmentioning

confidence: 99%

Elucidating survival and functional outcomes in patients with primary head and neck malignancies treated in academic versus community settings

Choi,

Patel,

Lane

et al. 2023

Head & Neck

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BackgroundDifferences in treatment outcomes between community or academic centers are incompletely understood.MethodsRetrospective review of head and neck cancer patients between 2010 and 2020 in a rural health region. Kaplan–Meier curves and log‐rank tests were used to evaluate survival outcomes, along with bivariate and multivariable Cox proportional hazards models. Linear regression was used for functional outcomes of tracheotomy and gastrostomy tube dependence.ResultsTwo hundred and forty‐eight patients treated at an academic center were compared with 94 patients treated in community centers. In multivariable analysis, the risk of death (HR = 0.60, p = 0.019), and risk of recurrence were lower (HR = 0.29, p < 0.001) for patients treated in academic centers. Patients treated in community centers had longer gastrostomy tube dependence (p = 0.002).ConclusionOur findings suggest that treatment at an academic center was associated with a lower risk of recurrence and shorter gastrostomy tube dependence compared to treatment in the community.

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Late Feeding Tube Dependency in Head and Neck Cancer Patients Treated with Definitive Radiation Therapy and Concurrent Systemic Therapy

Cited by 10 publications

References 29 publications

Routine Prophylactic Percutaneous Endoscopic Gastrostomy in Head and Neck Cancers with Bilateral Neck Irradiation: A Regional Cancer Experience in New Zealand

Routine Prophylactic Percutaneous Endoscopic Gastrostomy in Head and Neck Cancers with Bilateral Neck Irradiation: A Regional Cancer Experience in New Zealand

Impact of dosimetric factors on long-term percutaneous enteral gastrostomy (PEG) tube dependence in head and neck cancer patients after (chemo)radiotherapy—results from a prospective randomized trial

Elucidating survival and functional outcomes in patients with primary head and neck malignancies treated in academic versus community settings

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