Influence of dosimetric and clinical criteria on the requirement of artificial nutrition during radiotherapy of head and neck cancer patients.
Intensification of radiotherapy and chemotherapy for head-and-neck cancer (HNC) may lead to increased rates of long term dysphagia as a severe side effect. Mucositis and consequent swallowing problems require artificial nutrition in many HNC patients undergoing radiotherapy or chemoradiation. It is unknown, which predict factors for prophylactic PEG tube insertion appear useful.



From an institutional database, 101 patients (72 male, 29 female, mean age 59.5years) were identified who underwent radiotherapy or chemoradiation for HNC. Primary end point of the investigation was the need for artificial nutrition for more than 4days during radiotherapy. Dose volume parameters of defined normal tissue structures potentially of relevance for swallowing ability as well as clinical factors were used to develop a predictive model using a binary multiple logistic regression model.



Whereas several dosimetric and clinical factors were significant predictors for the need of artificial nutrition on univariate analysis, on multivariate analysis only three factors remained independently significant: mean dose to the oropharynx+1cm circumferential margin, ECOG performance state (0-1 vs. 2-4), and the use of chemotherapy (yes vs. no).



Using a 3 parameter model we could distinguish HNC-patients with different risks for the need of artificial nutrition during radiotherapy. After independent validation, the model could be helpful to decision on prophylactic PEG tube insertion.
Department of Radiation Oncology, Medical Faculty Heinrich Heine University Hospital Duesseldorf, Germany. Electronic address: matuschek@med.uni-duesseldorf.de.
Christiane
C
Matuschek
Department of Radiation Oncology, Medical Faculty Heinrich Heine University Hospital Duesseldorf, Germany.
Edwin
E
Bölke
Department of Radiation Oncology, Medical Faculty Heinrich Heine University Hospital Duesseldorf, Germany.
Caroline
C
Geigis
Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Kai
K
Kammers
Department of Radiation Oncology, Ludwig Maximilians University Hospital, Großhadern and Campus, Germany.
Ute
U
Ganswindt
Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Heinrich Heine University Hospital Duesseldorf, Germany.
Kathrin
K
Scheckenbach
Department of Radiation Oncology, Medical Faculty Heinrich Heine University Hospital Duesseldorf, Germany.
Stephan
S
Gripp
Department of Radiation Oncology, Medical Faculty Heinrich Heine University Hospital Duesseldorf, Germany.
Jannis
J
Simiantonakis
Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Germany.
Thomas K
TK
Hoffmann
Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Germany.
Jens
J
Greve
Department of Dermatology, Medical Faculty Heinrich Heine University Duesseldorf, Germany.
Peter Arne
PA
Gerber
Department of General, Visceral and Thoracic Surgery, Harzkliniken Goslar, Germany.
Klaus
K
Orth
Department of Radiation Oncology, Medical Faculty Heinrich Heine University Hospital Duesseldorf, Germany.
Henning
H
Roeder
Department of Radiotherapy, University of Regensburg, Germany.
Matthias G
MG
Hautmann
Department of Radiation Oncology, Medical Faculty Heinrich Heine University Hospital Duesseldorf, Germany.
Wilfried
W
Budach
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy / Q000009:adverse effects; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000532:radiotherapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D018529:Nutritional Support; D011832:Radiation Injuries / Q000628:therapy*; D011874:Radiometry
Artificial nutrition; Feeding tube; Head and neck cancer; PEG; Radiation therapy