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
Altmetric Score
MSK Authors
  1. Zhigang Zhang
    244 Zhang
  2. Weiji Shi
    115 Shi
  3. Nadeem Riaz
    211 Riaz
  4. Nancy Y. Lee
    550 Lee
  5. Jeremy Setton
    65 Setton