Sparing the larynx and esophageal inlet expedites feeding tube removal in patients with stage III‐IV oropharyngeal squamous cell carcinoma treated with intensity‐modulated radiotherapy

Amin, Neha; Reddy, Krishna; Westerly, D; Raben, David; DeWitt, Peter; Chen, Changhu

doi:10.1002/lary.23597

Cited by 20 publications

(30 citation statements)

References 10 publications

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“…These results support previous research, which has shown that PEG duration may not be entirely related to dysphagia frequency/severity [50,112]. PEG duration and long-term PEG dependence may also be associated with a number of other factors, including race [95], performance status scores (i.e., Zubrod) [95], age [87], gender [85,87], tumor stage/cancer severity [87,95,118,119], cancer site [85,120], smoking status [118,120], the presence/absence of pre-treatment dysphagia [118,119], and the level of support offered to patients when transitioning from tube to oral feeding [121,122]. Therefore, using PEG dependence/duration as a marker of dysphagia has its drawbacks and may not accurately reflect a patient's swallow physiology or function.…”

Section: Peg Dependence/durationsupporting

confidence: 86%

The Effect of Prophylactic Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement on Swallowing and Swallow-Related Outcomes in Patients Undergoing Radiotherapy for Head and Neck Cancer: A Systematic Review

et al. 2015

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Patients undergoing radiotherapy for head and neck cancer (HNC) often experience malnutrition and dehydration during treatment. As a result, some centres place PEG tubes prophylactically (pPEG) to prevent these negative consequences. However, recent research has suggested that pPEG use may negatively affect swallowing physiology, function and/or quality of life, especially in the long term. The purpose of this study was to systematically review the literature on pPEG use in HNC patients undergoing radiotherapy and to determine its impact on swallowing-related outcomes. The following electronic databases were searched for all relevant primary research published through February 24, 2014: AMED, CINAHL, the Cochrane Library, Embase, Healthstar, Medline, and PsycINFO. Main search terms included HNC, radiotherapy, deglutition disorders, feeding tube(s), and prophylactic or elective. References for all accepted papers were hand searched to identify additional relevant research. Methodological quality was assessed using Cochrane's Risk of Bias. At all levels, two blinded raters provided judgments. Discrepancies were resolved by consensus. The search retrieved 181 unique citations. Twenty studies met our inclusion criteria. Quality assessment revealed that all studies were at risk for bias due to non-randomized sampling and unreported or inadequate blinding. Ten studies demonstrated selection bias with significant baseline differences between pPEG patients and controls. Results regarding the frequency and severity of dysphagia and swallowing-related outcomes were varied and inconclusive. The impact of pPEG use on swallowing and swallowing-related outcomes remains unclear. Well-controlled, randomized trials are needed to determine if pPEG places patients at greater risk for developing long-term dysphagia.

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Section: Peg Dependence/durationsupporting

confidence: 86%

The Effect of Prophylactic Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement on Swallowing and Swallow-Related Outcomes in Patients Undergoing Radiotherapy for Head and Neck Cancer: A Systematic Review

et al. 2015

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“…Amin et al showed that by using IMRT planning to reduce the dose to the pharyngeal constrictor muscles and the larynx and esophageal inlet muscle, the duration of PEG-tube dependence could be reduced by 4.9 months [18]. Currently, a prospective study on swallowing-sparing IMRT is ongoing at our own department, and the results will be available soon.…”

Section: Discussionmentioning

confidence: 86%

“…One strategy for preventing swallowing dysfunction is to reduce the dose to anatomical structures that are important for swallowing by using advanced radiation delivery techniques such as intensity modulated radiotherapy (IMRT) [12][13][14][15][16][17][18]. However, radiotherapy treatment optimization requires information on the most important dose-volume parameters.…”

Section: Introductionmentioning

confidence: 99%

Development of a multivariable normal tissue complication probability (NTCP) model for tube feeding dependence after curative radiotherapy/chemo-radiotherapy in head and neck cancer

Wopken

Bijl

Schaaf

et al. 2014

Radiotherapy and Oncology

102

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“…Within the swallowing structures, the radiation dose delivered to the pharyngeal constrictors, particularly the superior pharyngeal constrictors, can predict the extent of RT-related dysphagia [35][36][37][38] and dysphagia-related effects on quality of life [39]. The dose-volume parameters with respect to the pharyngeal constrictor included the mean radiation dose [36,37], near maximal dose (D 2% ), which was defined a 2% volume of pharyngeal constrictor that received the radiation dose [35], and V 55Gy or V 65Gy , which was the relative volume that received at least the radiation dose of 55 or 65 Gy [38].…”

Section: Structures In the Head And Neckmentioning

confidence: 99%

Sparing Functional Anatomical Structures During Intensity-Modulated Radiotherapy: An Old Problem, A New Solution

et al. 2014

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During intensity-modulated radiotherapy, an organ is usually assumed to be functionally homogeneous and, generally, its anatomical and spatial heterogeneity with respect to radiation response are not taken into consideration. However, advances in imaging and radiation techniques as well as an improved understanding of the radiobiological response of organs have raised the possibility of sparing the critical functional structures within various organs at risk during intensity-modulated radiotherapy. Here, we discuss these structures, which include the critical brain structure, or neural nuclei, and the nerve fiber tracts in the CNS, head and neck structures related to radiation-induced salivary and swallowing dysfunction, and functional structures in the heart and lung. We suggest that these structures can be used as potential surrogate organs at risk in order to minimize their radiation dose and/or irradiated volume without compromising the dose coverage of the target volume during radiation treatment.

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Sparing the larynx and esophageal inlet expedites feeding tube removal in patients with stage III‐IV oropharyngeal squamous cell carcinoma treated with intensity‐modulated radiotherapy

Abstract: A dose constraint on the larynx and esophageal inlet during IMRT planning reduces dose to pharyngeal constrictors and expedites PEG tube removal.

Cited by 20 publications

References 10 publications

The Effect of Prophylactic Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement on Swallowing and Swallow-Related Outcomes in Patients Undergoing Radiotherapy for Head and Neck Cancer: A Systematic Review

The Effect of Prophylactic Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement on Swallowing and Swallow-Related Outcomes in Patients Undergoing Radiotherapy for Head and Neck Cancer: A Systematic Review

Development of a multivariable normal tissue complication probability (NTCP) model for tube feeding dependence after curative radiotherapy/chemo-radiotherapy in head and neck cancer

Sparing Functional Anatomical Structures During Intensity-Modulated Radiotherapy: An Old Problem, A New Solution

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