title: A multi-institution pooled analysis of gastrostomy tube dependence in patients with oropharyngeal cancer treated with definitive intensity-modulated radiotherapy.
abstract: BACKGROUND
  Severe swallowing dysfunction necessitating enteral support is a well known late sequela of nonsurgical therapy for oropharyngeal cancer, but its incidence after intensity-modulated radiotherapy has not been quantified comprehensively outside of small single-institution series.
  
  
  METHODS
  This was a multi-institution, institutional review board-approved, retrospective study. Consecutive patients with oropharyngeal squamous cell carcinoma who had received definitive intensity-modulated radiotherapy from 1998 to 2011 were identified from 3 academic centers.
  
  
  RESULTS
  In total, 2315 patients were included. The American Joint Committee on Cancer staging distribution was as follows: stage I, 2.1%; stage II, 4.4%; stage III, 14.7%; and stage IV, 77.3%. Among 1459 patients (63%) who received a gastrostomy tube (g-tube), placement was prophylactic in 52% and reactive in 48%. Among patients with stage III and IV disease, 58% received concurrent chemotherapy. The median follow-up was 43.7 months (range, 0.1-164 months). The g-tube dependence rate was 7% at 1 year and 3.7% at 2 years. Among 1238 patients with stage III and IV disease who received concurrent chemotherapy, the 1-year and 2-year rates of g-tube dependence were 8.6% and 4.4%, respectively. The 1-year g-tube dependence rate was 5% for patients with stage I and II disease; 5.2% for patients with stage III and IV, T1-T2/N0-N2 disease; and 10.1% for patients with stage III and IV, T3-T4 or N3 disease. On multivariate analysis, advanced age (odds ratio [OR], 1.066; P<.001), greater number of smoking pack-years (OR, 1.008; P=.04), advanced N-category (OR, 1.13; P=.049), and receipt of cytotoxic chemotherapy (OR, 2.26; P=.02) were predictive of g-tube dependence at 1 year.
  
  
  CONCLUSIONS
  This multi-institution series of 2315 patients treated at 3 institutions demonstrates that modern nonsurgical therapy for oropharyngeal cancer is associated with a low rate of long-term g-tube dependence.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Setton
authors.forename: Nancy Y
authors.initials: NY
authors.lastname: Lee
authors.forename: Nadeem
authors.initials: N
authors.lastname: Riaz
authors.forename: Shao-Hui
authors.initials: SH
authors.lastname: Huang
authors.forename: John
authors.initials: J
authors.lastname: Waldron
authors.forename: Brian
authors.initials: B
authors.lastname: O'Sullivan
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Zhang
authors.forename: Weij
authors.initials: W
authors.lastname: Shi
authors.forename: David I
authors.initials: DI
authors.lastname: Rosenthal
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Hutcheson
authors.forename: Adam S
authors.initials: AS
authors.lastname: Garden
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000532:radiotherapy* / Q000601:surgery; D059248:Chemoradiotherapy; D003680:Deglutition Disorders / Q000209:etiology* / Q000503:physiopathology; D004750:Enteral Nutrition; D005774:Gastrostomy / Q000379:methods; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D037981:Neck Dissection / Q000009:adverse effects; D009959:Oropharyngeal Neoplasms / Q000150:complications / Q000532:radiotherapy* / Q000601:surgery; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: G-tube; dysphagia; intensity-modulated radiotherapy; oropharyngeal cancer; percutaneous endoscopic gastrostomy