title: Pre-radiotherapy feeding tube identifies a poor prognostic subset of postoperative p16 positive oropharyngeal carcinoma patients.
abstract: BACKGROUND
  This study explores variables associated with poor prognosis in postoperative p16 positive oropharyngeal squamous cell carcinoma (OPSCC) patients undergoing adjuvant radiotherapy or chemoradiotherapy. Specifically, analysis was done related to timing of feeding tube insertion relative to radiotherapy.
  
  
  METHODS
  From 1997-2009, of 376 consecutive patients with OPSCC, 220 received adjuvant IMRT, and 97 were p16 positive and eligible. Of these, 23 had feeding tube placement before IMRT (B-FT), 32 during/after IMRT (DA-FT), and 42 had no feeding tube (NO-FT). Feeding tubes were not placed prophylactically. These three groups were analyzed for differential tumor, patient, treatment, and feeding tube characteristics, as well as differences in overall survival (OS), disease free survival (DFS), and distant metastasis free survival (DMFS).
  
  
  RESULTS
  Pre-RT FT insertion was associated with higher tumor size and depth, T (but not N) and overall stage, comorbidities, presence of chemotherapy, and less use of transoral laser microsurgery/transoral bovie. Additionally, time from surgery to IMRT completion was also statistically longer in the B-FT group. The feeding tube was permanent in 52% of patients in the B-FT group versus 16% in the DA-FT group (p = 0.0075). The 5-year OS for the NO-FT, DA-FT, and B-FT groups was 90%, 86%, and 50%, respectively. The 5-year DFS for the NO-FT, DA-FT, and B-FT groups was 87.6%, 83.6%, and 42.7%, respectively. Multivariate analysis showed that for OS and DFS, feeding tube placement timing and smoking history were statistically significant.
  
  
  CONCLUSIONS
  Due to the poor prognosis of early FT insertion, the presence of FTs at time of radiotherapy consultation can be used as an alternate marker to identify a subset of p16 positive OPSCC patients that have a poor prognosis.
authors.affiliation: Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA. vivek333@gmail.com.
authors.forename: Vivek
authors.initials: V
authors.lastname: Verma
authors.affiliation: Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA. esther@wubios.wustl.edu.
authors.forename: Jingxia
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Campus Box 8224, St. Louis, 63110-6311, Missouri, USA. leschen@radonc.wustl.edu.
authors.forename: Laura
authors.initials: L
authors.lastname: Eschen
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Campus Box 8224, St. Louis, 63110-6311, Missouri, USA. jdanieley@radonc.wustl.edu.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Danieley
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Campus Box 8224, St. Louis, 63110-6311, Missouri, USA. cspencer@radonc.wustl.edu.
authors.forename: Christopher
authors.initials: C
authors.lastname: Spencer
authors.affiliation: Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA. jlewis@path.wustl.edu.|Otolaryngology Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA. jlewis@path.wustl.edu.
authors.forename: James S
authors.initials: JS
authors.lastname: Lewis
authors.affiliation: Otolaryngology Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA. diazj@ent.wustl.edu.
authors.forename: Jason
authors.initials: J
authors.lastname: Diaz
authors.affiliation: Otolaryngology Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA. piccirilloj@ent.wustl.edu.
authors.forename: Jay F
authors.initials: JF
authors.lastname: Piccirillo
authors.affiliation: Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA. dadkins@DOM.wustl.edu.
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Adkins
authors.affiliation: Otolaryngology Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA. nussenbaumb@ent.wustl.edu.
authors.forename: Brian
authors.initials: B
authors.lastname: Nussenbaum
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Campus Box 8224, St. Louis, 63110-6311, Missouri, USA. wthorstad@radonc.wustl.edu.
authors.forename: Wade L
authors.initials: WL
authors.lastname: Thorstad
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Campus Box 8224, St. Louis, 63110-6311, Missouri, USA. hgay@radonc.wustl.edu.
authors.forename: Hiram A
authors.initials: HA
authors.lastname: Gay
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000378:metabolism / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D019941:Cyclin-Dependent Kinase Inhibitor p16; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000378:metabolism*; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000378:metabolism / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011184:Postoperative Period; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D015996:Survival Rate
chemical_list: C000614131:CDKN2A protein, human; D019941:Cyclin-Dependent Kinase Inhibitor p16; D009363:Neoplasm Proteins