Late Feeding Tube Dependency in Head and Neck Cancer Patients Treated with Definitive Radiation Therapy and Concurrent Systemic Therapy.
chemoradiation
dysphagia
head and neck cancer
peg dependency
peg tube
swallowing
veterans affairs
Journal
Cureus
ISSN: 2168-8184
Titre abrégé: Cureus
Pays: United States
ID NLM: 101596737
Informations de publication
Date de publication:
15 Apr 2020
15 Apr 2020
Historique:
entrez:
20
5
2020
pubmed:
20
5
2020
medline:
20
5
2020
Statut:
epublish
Résumé
Objective The study aimed to evaluate the impact of late swallowing dysfunction leading to percutaneous endoscopic gastrostomy (PEG) tube dependence on the overall survival (OS) in a cohort of locally advanced head and neck cancer patients treated and cured with definitive radiotherapy (RT) and concurrent systemic therapy (CST). Materials and methods A total of 62 patients with locally advanced head and neck cancer were included in the analysis based on the following selection criteria: stage III, IVA, or IVB disease, treated with definitive RT and CST, no major head and neck surgery, no evidence of local or distant recurrent disease, and at least one post-RT modified barium swallow study. Patients were classified as PEG dependent or PEG independent at the time of the last follow-up. Estimates of OS were calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed to evaluate the impact of various clinical factors on OS. Results The median follow-up was 48 months (range: 7.6-235 months). The five-year OS was 64.3% in the PEG-dependent group and 86.1% in the PEG-independent group (p=0.022). Age over 70 at diagnosis was also associated with poorer OS (p=0.044). On univariate analysis, PEG dependency maintained a significantly worse OS (hazard ratio [HR]: 2.59; 95% confidence interval [CI]: 1.11-5.99, p=0.028). On multivariate analysis, PEG dependency (HR: 4.25; 95% CI: 1.33-13.62; p=0.015), advanced N stage (HR: 4.74; 95% CI: 1.17-19.26, p=0.035), and older age at diagnosis (HR: 4.37; 95% CI: 1.21-15.84; p=0.025) were significantly associated with worse OS. Conclusions Late PEG dependency is associated with poor OS in head and neck cancer patients cured with definitive RT and CST. Interventions designed to help head and neck cancer patients maintain swallowing function may result in improved outcomes.
Identifiants
pubmed: 32426195
doi: 10.7759/cureus.7683
pmc: PMC7228799
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e7683Informations de copyright
Copyright © 2020, Friedes et al.
Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Front Oncol. 2017 Dec 05;7:299
pubmed: 29379770
Head Neck. 2014 Mar;36(3):431-43
pubmed: 23828486
Int J Radiat Oncol Biol Phys. 2000 May 1;47(2):277-90
pubmed: 10802350
Lancet Oncol. 2012 Feb;13(2):145-53
pubmed: 22261362
Head Neck. 2013 Nov;35(11):1634-40
pubmed: 23322563
JAMA Otolaryngol Head Neck Surg. 2013 Nov;139(11):1242-6
pubmed: 24136493
Int J Radiat Oncol Biol Phys. 2012 May 1;83(1):210-9
pubmed: 22014959
Cancer. 2015 Jan 15;121(2):294-301
pubmed: 25286832
Curr Opin Otolaryngol Head Neck Surg. 2007 Apr;15(2):130-3
pubmed: 17413416
BMC Cancer. 2016 Oct 6;16(1):770
pubmed: 27716125
Radiother Oncol. 2019 Jan;130:68-74
pubmed: 30551889
J Clin Oncol. 2003 Jan 1;21(1):92-8
pubmed: 12506176
Radiother Oncol. 2009 Jul;92(1):4-14
pubmed: 19446902
Radiother Oncol. 2019 Jan;130:62-67
pubmed: 30420235
J Clin Oncol. 2019 Oct 10;37(29):2661-2669
pubmed: 31411949
Int J Radiat Oncol Biol Phys. 2011 Nov 1;81(3):e93-9
pubmed: 21592678
Int J Radiat Oncol Biol Phys. 2002 May 1;53(1):23-8
pubmed: 12007937
Int J Radiat Oncol Biol Phys. 2010 Nov 15;78(4):1026-32
pubmed: 20231073
J Natl Cancer Inst. 2019 May 1;111(5):490-497
pubmed: 30239887
Arch Otolaryngol Head Neck Surg. 2012 Apr;138(4):376-82
pubmed: 22508621
Oral Oncol. 2016 Mar;54:15-27
pubmed: 26794879
J Clin Oncol. 2005 Feb 20;23(6):1125-35
pubmed: 15718308
Int J Radiat Oncol Biol Phys. 2004 Dec 1;60(5):1425-39
pubmed: 15590174
Cancer. 2012 Dec 1;118(23):5793-9
pubmed: 23640737
J Clin Oncol. 2008 Aug 1;26(22):3770-6
pubmed: 18669465
Dysphagia. 2011 Jun;26(2):155-70
pubmed: 20623305
Pract Radiat Oncol. 2015 Sep-Oct;5(5):343-349
pubmed: 25920699