Long term feeding tube use in head and neck cancer survivors - a secondary analysis of patient and treatment related factors.

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Abstract

This secondary analysis of three xxxxx head and neck cancer chemoradiation trials investigates feeding tube utilization up to nine years after treatment completion and attempts to identify predictive factors. Oropharynx cancer patients treated with 3D conformal radiation (3DCRT) with accelerated fractionation and concurrent chemotherapy had higher rates of long-term feeding tube utilization than those treated with 3DCRT conventional fractionation. However, when evaluating all patients treated (oropharynx and other subsites), intensity modulated radiation therapy (IMRT) had a protective effect, with significantly fewer long-term feeding tubes when compared to those treated with 3DCRT. For most oropharynx cancer patients, neither IMRT technique nor accelerated fractionation nor addition of cetuximab influenced the likelihood of long-term feeding tube usage. Most predictors of long-term feeding tube usage are patient factors known prior to treatment initiation.PURPOSE: The rate of long-term feeding tube usage for patients treated with definitive (chemo)radiation (CRT) is unknown. This analysis aims to determine predictive factors of feeding tube use years after treatment completion on xxxxx head and neck cancer trials that accrued from 2002-2014.MATERIALS AND METHODS: This is an unplanned, post-hoc secondary analysis of long term both oropharynx cancer (OPC) and all treated patient feeding tube rates 6 months to 9 years after CRT completion for patients treated on the multicenter prospective trials xxxxx, and xxxxx.RESULTS: Median (min-max) follow-up was 6.7 years (interquartile range: 3.4-8.2) for OPC patients. Five hundred ninety-eight of 1839 (33%) OPC patients had a feeding tube 6 months after treatment. This decreased to 4% at one year and 3% at 9 years. Predictors of a feeding tube post-treatment were treatment with 3D conformal (3DCRT) accelerated chemoradiation with concomitant boost (AFX3DCRT), older age, feeding tube at registration, T4 tumor stage, and >10 pack years of smoking. AFX3DCRT was independently significantly more associated with feeding tube use when compared to all other regimens. Among all treated patients (n=2387) the median followup was 6.3 years (interquartile range: 2.7-8.2). IMRT regimens had significantly less feeding tubes than 3DCRT (AFXIMRT?+?Cetux?+?C: HR 0.75 [0.63 - 0.89]; AFXIMRT?+?Cetux: HR 0.81 [0.67 - 0.98]) for all patients. Primary site did not significantly influence feeding tube utilization (Non tonsil/tongue base HR 0.97 [0.85-1.11]).CONCLUSIONS: 3DCRT accelerated fractionation CRT is associated with increased post-treatment feeding tube use for both OPC patients and all patients treated when compared to IMRT based regimens. Other predictors of post-treatment feeding tube use are largely know prior to treatment initiation. Patients treated with non tonsil/tongue base primary tumors did not have higher rates of feeding tube utilization.

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