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Annals of Oncology Advance Access published online on July 14, 2009
Annals of Oncology, doi:10.1093/annonc/mdp268
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Clinical and dosimetric factors associated with a prolonged feeding tube requirement in patients treated with chemoradiotherapy (CRT) for head and neck cancers

A. S. Gokhale1, B. T. McLaughlin2, J. C. Flickinger1, S. Beriwal1,*, D. E. Heron1, R. L. Ferris3, J. Johnson3, M. K. Gibson2, A. Argiris2 and R. P. Smith1

1 Department of Radiation Oncology
2 Division of Hematology–Oncology, Department of Medicine
3 Department of Otolaryngology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA

* Correspondence to: Dr. S. Beriwal, Department of Radiation Oncology, Magee-Women’s Hospital, University of Pittsburgh Cancer Institute, 300 Halket Street, Pittsburgh, PA 15213, USA. Tel: +1-412-641-4600; Fax: +1-412-641-1971; E-mail: beriwals{at}upmc.edu

Background: Patients treated with chemoradiotherapy (CRT) for head and neck cancers often require feeding tubes (FTs) due to toxicity. We sought to identify factors associated with a prolonged FT requirement.

Patients and methods: We retrospectively reviewed 80 patients treated with CRT for head and neck cancers. The pharyngeal constrictors (PCs), supraglottic larynx (SGL), and glottic larynx (GL) were contoured and the mean radiation doses and the volumes of each receiving >40, 50, 60, and 70 Gy (V40, V50, V60, and V70) were determined.

Results: A total of 33 of 80 patients required a FT either before or during the course of CRT. Fifteen patients required the FT for ≥6 months. On univariate analysis, significant factors associated with a prolonged FT requirement were mean PC dose, PC-V60, PC-V70, SGL dose, SGL-V70, and advanced T3–T4 disease. Multivariate analyses found both PC-V70 and T3-T4 disease as significant factors .The proportions of patients requiring a FT ≥6 months were 8% and 28% for treatment plans with PC-V70 <30% and ≥30%, respectively.

Conclusions: Increased radiation dose to the PCs is associated with a higher risk of a prolonged FT need. Dose sparing of the PC muscles may reduce this risk.

chemoradiation, dysphagia, feeding tubes, head and neck cancer, quality of life

Received for publication February 3, 2009. Revision received April 6, 2009. Accepted for publication April 7, 2009.


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