A multi-institution pooled analysis of gastrostomy tube dependence in patients with oropharyngeal cancer treated with definitive intensity-modulated radiotherapy Journal Article
| Authors: | Setton, J.; Lee, N. Y.; Riaz, N.; Huang, S. H.; Waldron, J.; O'Sullivan, B.; Zhang, Z.; Shi, W.; Rosenthal, D. I.; Hutcheson, K. A.; Garden, A. S. |
| Article Title: | A multi-institution pooled analysis of gastrostomy tube dependence in patients with oropharyngeal cancer treated with definitive intensity-modulated radiotherapy |
| Abstract: | BACKGROUND: Severe swallowing dysfunction necessitating enteral support is a well known late sequela of nonsurgical therapy for oropharyngeal cancer, but its incidence after intensity-modulated radiotherapy has not been quantified comprehensively outside of small single-institution series. METHODS: This was a multi-institution, institutional review board-approved, retrospective study. Consecutive patients with oropharyngeal squamous cell carcinoma who had received definitive intensity-modulated radiotherapy from 1998 to 2011 were identified from 3 academic centers. RESULTS: In total, 2315 patients were included. The American Joint Committee on Cancer staging distribution was as follows: stage I, 2.1%; stage II, 4.4%; stage III, 14.7%; and stage IV, 77.3%. Among 1459 patients (63%) who received a gastrostomy tube (g-tube), placement was prophylactic in 52% and reactive in 48%. Among patients with stage III and IV disease, 58% received concurrent chemotherapy. The median follow-up was 43.7 months (range, 0.1-164 months). The g-tube dependence rate was 7% at 1 year and 3.7% at 2 years. Among 1238 patients with stage III and IV disease who received concurrent chemotherapy, the 1-year and 2-year rates of g-tube dependence were 8.6% and 4.4%, respectively. The 1-year g-tube dependence rate was 5% for patients with stage I and II disease; 5.2% for patients with stage III and IV, T1-T2/N0-N2 disease; and 10.1% for patients with stage III and IV, T3-T4 or N3 disease. On multivariate analysis, advanced age (odds ratio [OR], 1.066; P<.001), greater number of smoking pack-years (OR, 1.008; P=.04), advanced N-category (OR, 1.13; P=.049), and receipt of cytotoxic chemotherapy (OR, 2.26; P=.02) were predictive of g-tube dependence at 1 year. CONCLUSIONS: This multi-institution series of 2315 patients treated at 3 institutions demonstrates that modern nonsurgical therapy for oropharyngeal cancer is associated with a low rate of long-term g-tube dependence. |
| Keywords: | adult; cancer chemotherapy; aged; major clinical study; intensity modulated radiation therapy; percutaneous endoscopic gastrostomy; stomach tube; cancer patient; cancer staging; follow up; incidence; smoking; age; dysphagia; intensity-modulated radiotherapy; multicenter study; prophylaxis; long term care; mouth squamous cell carcinoma; oropharyngeal cancer; human; male; female; article; larynx squamous cell carcinoma; g-tube |
| Journal Title: | Cancer |
| Volume: | 121 |
| Issue: | 2 |
| ISSN: | 0008-543X |
| Publisher: | Wiley Blackwell |
| Date Published: | 2015-01-15 |
| Start Page: | 294 |
| End Page: | 301 |
| Language: | English |
| DOI: | 10.1002/cncr.29022 |
| PROVIDER: | scopus |
| PUBMED: | 25286832 |
| PMCID: | PMC5508491 |
| DOI/URL: | |
| Notes: | Export Date: 2 February 2015 -- Source: Scopus |
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