Long-Term Feeding Tube Use in Head and Neck Cancer Survivors-An Analysis of Patient- and Treatment-Related Factors.

Abstract

The rate of long-term feeding tube usage for patients treated with definitive (chemo)radiation is unknown. This analysis aims to determine predictive factors of feeding tube use years after treatment completion on NRG Oncology head and neck cancer trials that accrued from 2002 to 2014. This is an unplanned, post hoc secondary analysis in the long term of both oropharynx cancer (OPC) and all treated patient feeding tube rates 6 months to 9 years after chemoradiation completion for patients treated on the multicenter prospective trialsNRG/RTOG 0129, 0522, and 1016. 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 1 year and 3% at 9 years. Predictors of a feeding tube posttreatment 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 follow-up was 6.3 years (interquartile range, 2.7-8.2). Intensity modulated radiation therapy (IMRT) regimens had significantly less feeding tubes than 3DCRT (AFXIMRT + Cetux + C: hazard ratios [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 (nontonsil/tongue base HR, 0.97 [0.85-1.11]). 3DCRT accelerated fractionation chemoradiation is associated with increased posttreatment feeding tube use for both OPC patients and all patients treated when compared to IMRT-based regimens. Other predictors of posttreatment feeding tube use are largely known prior to treatment initiation. Patients treated for nontonsil/tongue base primary tumors did not have higher rates of feeding tube utilization.