Percutaneous endoscopic gastrostomy in oropharyngeal cancer patients treated with intensity-modulated radiotherapy with concurrent chemotherapy Journal Article

   

Authors:	Romesser, P. B.; Romanyshyn, J. C.; Schupak, K. D.; Setton, J.; Riaz, N.; Wolden, S. L.; Gelblum, D. Y.; Sherman, E. J.; Kraus, D.; Lee, N. Y.
Article Title:	Percutaneous endoscopic gastrostomy in oropharyngeal cancer patients treated with intensity-modulated radiotherapy with concurrent chemotherapy
Abstract:	BACKGROUND: The clinical benefit of routine placement of prophylactic percutaneous endoscopic gastrostomy (pPEG) tubes was assessed in patients with oropharyngeal cancer (OPC) who are undergoing intensity-modulated radiotherapy (IMRT) with concurrent chemotherapy. METHODS: From 1998 through 2009, 400 consecutive patients with OPC who underwent chemoradiation were included. Of these, 325 had a pPEG and 75 did not (nPEG). Weight and albumin change from baseline to mid-IMRT, end of IMRT, 1 month post-IMRT, and 3 months post-IMRT were evaluated. The treating physicians prospectively recorded acute and late toxicities. RESULTS: Significantly lower absolute weight loss at end of IMRT (6.80 kg vs 8.38 kg, P =.007), 1 month post-IMRT (9.06 kg vs 11.33 kg, P =.006), and 3 months post-IMRT (11.10 kg vs 13.09 kg, P =.044) was noted in the pPEG versus nPEG groups. This benefit in reduction of percent weight loss was consistently significant only among patients with BMI < 25. Significant differences were noted in hospital admission rate (15.1% vs 26.7%, P =.026) and volume of nonchemotherapy hydration (8.9 liters vs 17.2 liters, P =.004). There were no differences in percent albumin change, acute dysphagia, acute mucositis, acute xerostomia, chronic dysphagia, radiation treatment duration, and overall survival. Multivariate analysis noted age >55 years (P <.001), female sex (P <.001), and T3/4 category disease (P <.001) were significantly associated with prolonged PEG use. CONCLUSIONS: Although pPEG reduced absolute and percent weight loss and need for hospitalizations in our cohort of patients with OPC undergoing chemoradiation, no differences were noted in radiation treatment duration, toxicity, and overall survival. Prolonged PEG use correlated with age >55 years, female sex, and T3/T4 tumors. © 2012 American Cancer Society.
Keywords:	adult; cancer chemotherapy; cancer survival; treatment response; aged; aged, 80 and over; middle aged; survival rate; retrospective studies; major clinical study; overall survival; intensity modulated radiation therapy; percutaneous endoscopic gastrostomy; bevacizumab; cisplatin; fluorouracil; treatment duration; cancer radiotherapy; combined modality therapy; cancer staging; drug megadose; outcome assessment; follow up; follow-up studies; neoplasm staging; carboplatin; multiple cycle treatment; mucosa inflammation; antineoplastic combined chemotherapy protocols; cohort analysis; body weight; weight reduction; continuous infusion; cetuximab; dysphagia; hospitalization; body mass; intensity-modulated radiotherapy; radiotherapy, intensity-modulated; xerostomia; oropharynx cancer; hospital admission; clinical effectiveness; age distribution; gender; hydration; gastrostomy; chemoradiotherapy; oropharyngeal neoplasms; pharynx cancer; albumin blood level; oropharyngeal cancer
Journal Title:	Cancer
Volume:	118
Issue:	24
ISSN:	0008-543X
Publisher:	Wiley Blackwell
Date Published:	2012-11-15
Start Page:	6072
End Page:	6078
Language:	English
DOI:	10.1002/cncr.27633
PROVIDER:	scopus
PUBMED:	22707358
PMCID:	PMC4969004
DOI/URL:	http://www.scopus.com/inward/record.url?eid=2-s2.0-84870655472&partnerID=40&md5=3f738f479137a5db6b9661149c4d8c25
Notes:	--- - "Export Date: 2 January 2013" - "CODEN: CANCA" - "Source: Scopus"

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