title: Risk factors for percutaneous endoscopic gastrostomy tube placement during chemoradiotherapy for oropharyngeal cancer.
abstract: OBJECTIVE
  Patients with oropharyngeal squamous cell carcinoma undergoing chemoradiotherapy may require percutaneous endoscopic gastrostomy (PEG) tube placement because of dehydration or significant weight loss.
  
  
  OBJECTIVE
  To determine the need for the reactive placement of a PEG tube during chemoradiotherapy for oropharyngeal cancer and to identify patient or tumor factors associated with reactively requiring the placement of a PEG tube.
  
  
  METHODS
  Single-institution retrospective review of 297 patients treated with intensity-modulated radiation therapy and concurrent chemotherapy for oropharyngeal squamous cell carcinoma between May 1, 2004, and June 30, 2012, with a minimum follow-up period of 3 months.
  
  
  METHODS
  Placement of a PEG tube.
  
  
  METHODS
  Logistic regression analysis was used to identify independent risk factors associated with symptomatic requirement for the reactive placement of a PEG tube.
  
  
  RESULTS
  In total, 128 patients did not receive a prophylactic PEG tube within 10 days of initiation of chemoradiotherapy. Fifteen of 128 patients (11.7%) required the reactive placement of a PEG tube during or within 3 months of chemoradiotherapy. The median time to PEG tube removal was 3.3 months, and 14 of 15 patients had their PEG tube removed at the last follow-up analysis. Independent risk factors for PEG tube placement included the following: accelerated irradiation fractionation (odds ratio, 4.3; 95% CI, 1.1-16.5; P = .04), a tumor T classification of 3 or higher (odds ratio, 3.5; 95% CI, 1.0-11.9; P = .04), a cumulative cisplatin dose of 200 mg/m² or higher (odds ratio, 6.7; 95% CI, 1.2-36.7; P = .03), and a body mass index (calculated as weight in kilograms divided by height in meters squared) of less than 25 (odds ratio, 5.8; 95% CI, 1.4-23.9; P = .02).
  
  
  CONCLUSIONS
  Although the overall risk is low, a body mass index of less than 25, accelerated irradiation fractionation, a tumor T classification of 3 or higher, and a cumulative cisplatin dose of 200 mg/m² or higher are associated with symptomatic need for the reactive placement of a PEG tube in patients with oropharyngeal cancer.
authors.affiliation: Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Tobin
authors.initials: T
authors.lastname: Strom
authors.forename: Andy M
authors.initials: AM
authors.lastname: Trotti
authors.forename: Julie
authors.initials: J
authors.lastname: Kish
authors.forename: Nikhil G
authors.initials: NG
authors.lastname: Rao
authors.forename: Judith
authors.initials: J
authors.lastname: McCaffrey
authors.forename: Tapan A
authors.initials: TA
authors.lastname: Padhya
authors.forename: Hui-Yi
authors.initials: HY
authors.lastname: Lin
authors.forename: William
authors.initials: W
authors.lastname: Fulp
authors.forename: Jimmy J
authors.initials: JJ
authors.lastname: Caudell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D059248:Chemoradiotherapy; D003680:Deglutition Disorders / Q000453:epidemiology / Q000517:prevention & control*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004750:Enteral Nutrition / Q000295:instrumentation*; D005260:Female; D005431:Florida / Q000453:epidemiology; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors