Influence of dosimetric and clinical criteria on the requirement of artificial nutrition during radiotherapy of head and neck cancer patients

• Published in: Radiotherapy and oncology 2016-07, Vol.120 (1), p.28-35
• Main Authors: Matuschek, Christiane, Bölke, Edwin, Geigis, Caroline, Kammers, Kai, Ganswindt, Ute, Scheckenbach, Kathrin, Gripp, Stephan, Simiantonakis, Jannis, Hoffmann, Thomas K, Greve, Jens, Gerber, Peter Arne, Orth, Klaus, Roeder, Henning, Hautmann, Matthias G, Budach, Wilfried
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Artificial nutrition; Chemoradiotherapy - adverse effects; Feeding tube; Female; Head and neck cancer; Head and Neck Neoplasms - complications; Head and Neck Neoplasms - radiotherapy; Hematology, Oncology and Palliative Medicine; Humans; Logistic Models; Male; Middle Aged; Models, Theoretical; Nutritional Support; PEG; Radiation Injuries - therapy; Radiation therapy; Radiometry
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2016.05.017

Abstract Purpose/objective(s) Intensification of radiotherapy and chemotherapy for head-and-neck cancer (HNC) may lead to increased rates of long term dysphagia as a severe side effect. Mucositis and consequent swallowing problems require artificial nutrition in many HNC patients undergoing radiotherapy or chemoradiation. It is unknown, which predict factors for prophylactic PEG tube insertion appear useful. Materials/methods From an institutional database, 101 patients (72 male, 29 female, mean age 59.5 years) were identified who underwent radiotherapy or chemoradiation for HNC. Primary end point of the investigation was the need for artificial nutrition for more than 4 days during radiotherapy. Dose volume parameters of defined normal tissue structures potentially of relevance for swallowing ability as well as clinical factors were used to develop a predictive model using a binary multiple logistic regression model. Results Whereas several dosimetric and clinical factors were significant predictors for the need of artificial nutrition on univariate analysis, on multivariate analysis only three factors remained independently significant: mean dose to the oropharynx + 1 cm circumferential margin, ECOG performance state (0–1 vs. 2–4), and the use of chemotherapy (yes vs. no). Conclusions Using a 3 parameter model we could distinguish HNC-patients with different risks for the need of artificial nutrition during radiotherapy. After independent validation, the model could be helpful to decision on prophylactic PEG tube insertion.