Reduced feeding tube duration with intensity-modulated radiation therapy for head and neck cancer: A Surveillance, Epidemiology, and End Results-Medicare Analysis.
Intensity-modulated radiation therapy (IMRT) is a technologically advanced and resource-intensive method of delivering radiation therapy (RT) and is used to minimize toxicity for patients with head and neck cancer (HNC). Dependence on feeding tubes is a significant marker of toxicity of RT. The objective of this analysis was to compare the placement and duration of feeding tube use among patients with HNC from 1999 through 2011.



The cohort, demographics, and cancer-related variables were determined using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database, and claims data were used to analyze treatment details.



In total, 2993 patients were identified. At a median follow-up of 47 months, 54.4% of patients had ever had a feeding tube placed. The median duration from feeding tube placement to removal was 277 days. On zero-inflated negative binomial regression, patients who received IMRT and 3-dimensional RT (3DRT) (non-IMRT) had similar rates of feeding tube placement (odds ratio, 1.10; P = .35); however, patients who received 3DRT had a feeding tube in place 1.18 times longer than those who received IMRT (P = .03). The difference was only observed among patients who received definitive RT; patients who underwent surgery and also received adjuvant RT had no statistically significant difference in feeding tube placement or duration.



Patients with HNC who received definitive IMRT had a significantly shorter duration of feeding tube placement than those who received 3DRT. These data suggest that there may be significant quality-of-life benefits to IMRT with respect to long-term swallowing function in patients with HNC. Cancer 2017;123:283-293. © 2016 American Cancer Society.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Beth M
BM
Beadle
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Kai-Ping
KP
Liao
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Sharon H
SH
Giordano
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Adam S
AS
Garden
Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Katherine A
KA
Hutcheson
Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Stephen Y
SY
Lai
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
B Ashleigh
BA
Guadagnolo
D000368:Aged; D000369:Aged, 80 and over; D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D006278:Medicare; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods; D018426:SEER Program; D014481:United States
dysphagia; feeding tube; head and neck cancer; intensity-modulated radiation therapy (IMRT); population-based data
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