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

Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
Annals of Oncology (Impact Factor: 7.04). 07/2009; 21(1):145-51. DOI: 10.1093/annonc/mdp268
Source: PubMed


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.
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.
A total of 33 of 80 patients required a FT either before or during the course of CRT. Fifteen patients required the FT for > or = 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 > or = 6 months were 8% and 28% for treatment plans with PC-V70 <30% and > or = 30%, respectively.
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.

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    • "Head and neck cancer survivors with chronic aspiration following treatment may develop anxiety and depression because of social isolation, which may severely impact on their quality of life. Recent studies suggest a correlation between radiation dose to the pharyngeal constrictor muscles and the risk of tube feeding dependence following head and neck radiotherapy [2], [3]. New radiotherapy techniques such as intensity-modulated radiotherapy (IMRT) may decrease dysphagia severity and the need for gastrostomy tubes because of decreased radiation dose to critical structures for swallowing. "
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    Full-text · Article · Feb 2011 · Radiologia Brasileira
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