title: Impact of feeding tube choice on severe late dysphagia after definitive chemoradiotherapy for human papillomavirus-negative head and neck cancer.
abstract: Severe late dysphagia is common after chemoradiotherapy for cancers of the larynx and oropharynx. Options for reduction of severe late dysphagia are limited for human papillomavirus (HPV)-negative patients. In this study, the role of feeding tube choice in severe late dysphagia is investigated.
  
  
  
  Patients disease-free after chemoradiotherapy for HPV-negative cancers of the laryngopharynx who received a feeding tube on-treatment were identified. The incidence of severe late dysphagia after reactive nasogastric (R-NG), proactive or reactive percutaneous gastrostomy (P-PEG or R-PEG) was assessed using log-rank and Cox analyses.
  
  
  
  Seventy-eight patients received a feeding tube on-treatment and remained disease-free. Median follow-up was 64 months. The 5-year incidence of severe late dysphagia was 30.8% in the R-NG cohort (n = 36), 56.4% in the R-PEG (n = 17; p = .193), and 60.9% in the P-PEG (n = 25; p = .016) cohorts. On multivariate analysis, percutaneous gastrostomy (PEG) feeding was independently associated with an increased rate of severe late dysphagia.
  
  
  
  R-NG use during chemoradiotherapy is associated with less severe late dysphagia and is preferred over PEG. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1054-E1060, 2016.
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Ward
authors.affiliation: Department of Hospital Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Priyanka
authors.initials: P
authors.lastname: Bhateja
authors.affiliation: Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Tobenna
authors.initials: T
authors.lastname: Nwizu
authors.affiliation: Speech Pathology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Joann
authors.initials: J
authors.lastname: Kmiecik
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Chandana A
authors.initials: CA
authors.lastname: Reddy
authors.affiliation: Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Joseph
authors.initials: J
authors.lastname: Scharpf
authors.affiliation: Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Lamarre
authors.affiliation: Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Brian B
authors.initials: BB
authors.lastname: Burkey
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: John F
authors.initials: JF
authors.lastname: Greskovich
authors.affiliation: Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: David J
authors.initials: DJ
authors.lastname: Adelstein
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Shlomo A
authors.initials: SA
authors.lastname: Koyfman
mesh_terms: D000368:Aged; D059248:Chemoradiotherapy / Q000009:adverse effects*; D003680:Deglutition Disorders / Q000503:physiopathology*; D004750:Enteral Nutrition; D005260:Female; D005774:Gastrostomy; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D027383:Papillomaviridae; D012189:Retrospective Studies
keywords: feeding tube; human papillomavirus (HPV)-negative; larynx; late dysphagia; percutaneous gastrostomy (PEG)