JAMA Otol Logo Orlando 2013 AHNS Meeting Location
American Head & Neck Society
Annual Meeting, April 10-11, 2013
JW Marriott Grande Lakes
Orlando, Florida

During the
Combined Otolaryngology Spring Meeting
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Presentation: S021
Topic: Clinical - Outcomes Research
Type: Oral Presentation
Date: Thursday, April 11, 2013
Session: 08:00 AM - 09:00 AM Thyroid / General
Authors: Tobin Strom, MD, Andy Trotti, MD, Nikhil G Rao, MD, Julie A Kish, MD, Judith C McCaffrey, MD, Tapan Padhya, MD, Jimmy J Caudell, MD, PhD
Institution(s): H. Lee Moffitt Cancer Center

Background. Percutaneous endoscopic gastrostomy tubes may be necessary for patients with oropharyngeal squamous cell carcinoma (OPSCC) undergoing chemoradiotherapy (CRT) due to dehydration or significant weight loss. We sought to review the need for a reactive PEG tube placement and hypothesized there would be patient or tumor factors that would be associated with the need for a reactive PEG tube placement.

Methods. Of 430 patients receiving CRT for OPSCC from May 2004 through June 2012, we identified 242 patients who did not receive a prophylactic PEG tube prior to, or within, 10 days of initiation of CRT, unless an attempt to prevent upfront placement of a PEG tube was explicitly indicated in the chart. Inclusion criteria included treatment with IMRT and chemotherapy and a minimum follow-up of 3 months. Exclusion criteria were prior head and neck surgery, prior head and neck cancer, induction chemotherapy, synchronous primary or locoregional recurrence or persistence of disease within 3 months of completing CRT. Patient demographics, tumor status, treatment, as well as information regarding who reactively required a PEG tube during or 3 months following completion of CRT, were abstracted. The Mann-Whitney U test and the Pearson’s Chi-square test were used to compare groups. Multivariate analysis was performed using a logistic regression model on potential predictors from univariate analysis.

Results. We identified 128 patients who did not receive a prophylactic PEG tube. Reactive placement of a PEG tube occurred during, or 3 months following, CRT in 15 patients (12%). Nine patients (7%) had a PEG tube at 3 months follow-up. On univariate analysis, a tumor T-stage ≥ 3 (p=0.05), a cumulative cisplatin dose ≥ 200 mg/m2 (p=0.03), and the DAHANCA radiation schedule (p=0.02), were significantly associated with the placement of a reactive PEG tube during treatment. A BMI < 25 kg/m2 showed a trend toward significance on univariate analysis (p=0.10). On multivariate analysis, a tumor T-stage ≥ 3 (OR 3.5, 95%CI 1.0-11.9, p=0.03), a cumulative cisplatin dose ≥ 200 mg/m2 (OR 6.7, 95%CI 1.2-36.7, p=0.03), the DAHANCA radiation schedule (OR 4.2, 95%CI 1.1-16.5, p=0.04), and a BMI < 25 kg/m2 (OR 5.8, 95%CI 1.4-23.9, p=0.02) were significantly associated with the placement of a reactive PEG tube.

Conclusions. Only 12% of OPSCC patients at our institution required the reactive placement of a PEG tube at some point within 3 months of the completion of CRT. A tumor T-stage ≥ 3, a cumulative cisplatin dose ≥ 200 mg/m2, the DAHANCA radiation schedule, and a BMI < 25 kg/m2 are associated with symptomatic need for PEG placement.

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