title: Development and validation of a prediction model for tube feeding dependence after curative (chemo-) radiation in head and neck cancer.
abstract: BACKGROUND
  Curative radiotherapy or chemoradiation for head and neck cancer (HNC) may result in severe acute and late side effects, including tube feeding dependence. The purpose of this prospective cohort study was to develop a prediction model for tube feeding dependence 6 months (TUBEM6) after curative (chemo-) radiotherapy in HNC patients.
  
  
  METHODS
  Tube feeding dependence was scored prospectively. To develop the multivariable model, a group LASSO analysis was carried out, with TUBEM6 as the primary endpoint (n = 427). The model was then validated in a test cohort (n = 183). The training cohort was divided into three groups based on the risk of TUBEM6 to test whether the model could be extrapolated to later time points (12, 18 and 24 months).
  
  
  RESULTS
  Most important predictors for TUBEM6 were weight loss prior to treatment, advanced T-stage, positive N-stage, bilateral neck irradiation, accelerated radiotherapy and chemoradiation. Model performance was good, with an Area under the Curve of 0.86 in the training cohort and 0.82 in the test cohort. The TUBEM6-based risk groups were significantly associated with tube feeding dependence at later time points (p<0.001).
  
  
  CONCLUSIONS
  We established an externally validated predictive model for tube feeding dependence after curative radiotherapy or chemoradiation, which can be used to predict TUBEM6.
authors.affiliation: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Kim
authors.initials: K
authors.lastname: Wopken
authors.affiliation: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Hendrik P
authors.initials: HP
authors.lastname: Bijl
authors.affiliation: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Arjen
authors.initials: A
authors.lastname: van der Schaaf
authors.affiliation: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Miranda E
authors.initials: ME
authors.lastname: Christianen
authors.affiliation: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Olga
authors.initials: O
authors.lastname: Chouvalova
authors.affiliation: Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Sjoukje F
authors.initials: SF
authors.lastname: Oosting
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Bernard F A M
authors.initials: BF
authors.lastname: van der Laan
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Jan L N
authors.initials: JL
authors.lastname: Roodenburg
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: C René
authors.initials: CR
authors.lastname: Leemans
authors.affiliation: Department of Radiation Oncology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Slotman
authors.affiliation: Department of Radiation Oncology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Patricia
authors.initials: P
authors.lastname: Doornaert
authors.affiliation: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Roel J H M
authors.initials: RJ
authors.lastname: Steenbakkers
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Irma M
authors.initials: IM
authors.lastname: Verdonck-de Leeuw
authors.affiliation: Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Langendijk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy / Q000009:adverse effects*; D015331:Cohort Studies; D003657:Decision Making; D004750:Enteral Nutrition; D005260:Female; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D018579:Patient Selection; D011446:Prospective Studies; D013997:Time Factors; D055815:Young Adult
references.citation: Radiother Oncol. 2008 May;87(2):195-200
references.pmid: 18342966
references.citation: Lancet. 2003 Sep 20;362(9388):933-40
references.pmid: 14511925
references.citation: Int J Radiat Oncol Biol Phys. 2005 Mar 1;61(3):772-8
references.pmid: 15708256
references.citation: Cancer. 2001 May 1;91(9):1785-90
references.pmid: 11335904
references.citation: Int J Radiat Oncol Biol Phys. 2009 Oct 1;75(2):385-92
references.pmid: 19553033
references.citation: Int J Radiat Oncol Biol Phys. 2002 May 1;53(1):23-8
references.pmid: 12007937
references.citation: Lancet. 2006 Sep 2;368(9538):843-54
references.pmid: 16950362
references.citation: J Clin Oncol. 2010 Jun 1;28(16):2732-8
references.pmid: 20421546
references.citation: Arch Otolaryngol Head Neck Surg. 2012 Apr;138(4):376-82
references.pmid: 22508621
references.citation: ANZ J Surg. 2009 Oct;79(10):713-8
references.pmid: 19878166
references.citation: Int J Radiat Oncol Biol Phys. 2004 Dec 1;60(5):1425-39
references.pmid: 15590174
references.citation: Arch Otolaryngol Head Neck Surg. 2004 Apr;130(4):401-8
references.pmid: 15096421
references.citation: Laryngoscope. 2008 Jan;118(1):39-43
references.pmid: 17989581
references.citation: Int J Radiat Oncol Biol Phys. 2008 Nov 15;72(4):1110-8
references.pmid: 18468812
references.citation: Int J Radiat Oncol Biol Phys. 2001 Aug 1;50(5):1161-71
references.pmid: 11483325
references.citation: J Clin Oncol. 2004 Nov 15;22(22):4604-12
references.pmid: 15542811
references.citation: Radiother Oncol. 2012 Oct;105(1):107-14
references.pmid: 21907437
references.citation: Radiother Oncol. 2012 Apr;103(1):69-75
references.pmid: 22398313
references.citation: Med Decis Making. 1993 Jan-Mar;13(1):49-58
references.pmid: 8433637
references.citation: J Clin Oncol. 2005 May 1;23(13):3008-15
references.pmid: 15860857
references.citation: Radiother Oncol. 2009 Dec;93(3):539-44
references.pmid: 19883951
references.citation: Laryngoscope. 2007 Feb;117(2):238-41
references.pmid: 17277616
references.citation: Int J Radiat Oncol Biol Phys. 2012 Mar 15;82(4):e677-84
references.pmid: 22245199
references.citation: Radiother Oncol. 2007 Oct;85(1):64-73
references.pmid: 17714815
references.citation: Radiother Oncol. 2009 Feb;90(2):189-95
references.pmid: 19167120
references.citation: Epidemiology. 2010 Jan;21(1):128-38
references.pmid: 20010215
references.citation: J Clin Oncol. 2008 Aug 1;26(22):3770-6
references.pmid: 18669465
references.citation: Radiother Oncol. 2003 Mar;66(3):253-62
references.pmid: 12742264
references.citation: Radiother Oncol. 2009 Jul;92(1):4-14
references.pmid: 19446902
references.citation: Am J Epidemiol. 2010 Oct 15;172(8):971-80
references.pmid: 20807737