1
|
Dysphagia, Speech, Voice, and Trismus following Radiotherapy and/or Chemotherapy in Patients with Head and Neck Carcinoma: Review of the Literature. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6086894. [PMID: 27722170 PMCID: PMC5045989 DOI: 10.1155/2016/6086894] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/01/2016] [Indexed: 01/19/2023]
Abstract
Introduction. Patients with head and neck cancer suffer from various impairments due to the primary illness, as well as secondary consequences of the oncological treatment. This systematic review describes the effects of radiotherapy and/or chemotherapy on the functions of the upper aerodigestive tract in patients with head and neck cancer. Methods. A systematic literature search was performed by two independent reviewers using the electronic databases PubMed and Embase. All dates up to May 2016 were included. Results. Of the 947 abstracts, sixty articles met the inclusion criteria and described one or more aspects of the sequelae of radiotherapy and/or chemotherapy. Forty studies described swallowing-related problems, 24 described voice-related problems, seven described trismus, and 25 studies described general quality of life. Only 14 articles reported that speech pathologists conducted the interventions, of which only six articles described in detail what the interventions involved. Conclusion. In general, voice quality improved following intervention, whereas quality of life, dysphagia, and oral intake deteriorated during and after treatment. However, as a consequence of the diversity in treatment protocols and patient characteristics, the conclusions of most studies cannot be easily generalised. Further research on the effects of oncological interventions on the upper aerodigestive tract is needed.
Collapse
|
2
|
Chen DW, Lewin JS, Xu L, Lai SY, Gunn GB, Fuller CD, Mohamed ASR, Kanwar A, Sturgis EM, Hutcheson KA. Feeding Tube Utilization in Patients with Salivary Gland Malignancies. Otolaryngol Head Neck Surg 2016; 156:109-117. [PMID: 27576681 DOI: 10.1177/0194599816666038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To evaluate feeding tube utilization in patients with salivary gland malignancies (SGMs). Study Design Case series with planned data collection. Setting The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. Subjects and Methods Patients (N = 287) were sampled from an epidemiologic SGM registry during a 12-year period. Feeding tube history was retrospectively reviewed. Patients with outside locoregional therapy or palliative treatment were excluded. Enteral feeding and length of dependence were analyzed as a function treatment modality and site of SGM. Results Of 287 patients, 79 (28%) required temporary nasogastric tube feeding (median duration: 13 days, interquartile range: 6-21). Among those 79, 30 (10% of total cohort) required conversion to percutaneous gastrostomy tube (G-tube). Median G-tube duration was 4.8 months (interquartile range: 3.7-13.1). G-tube placement was necessary only in patients receiving multimodality therapy ( P < .001), and among those, 50% with SGMs arising from pharyngeal/laryngeal sites required G-tube, as compared with 8% to 19% of SGMs arising from all other sites ( P < .01). At a median follow-up of 2.4 years, 9 (3%) of all SGM patients were G-tube dependent, but 14% (3 of 22) with laryngeal/pharyngeal sites treated with multimodality therapy remained chronically G-tube dependent. Conclusion While almost 30% of SGM survivors require a temporary nasogastric tube, G-tube utilization is uncommon, in roughly 10% of SGM overall. G-tube utilization appears exclusive to patients treated with multimodality therapy, and chronic gastrostomy remains high (14%) in patients with minor gland cancers arising in the pharynx/larynx, suggesting impetus for dysphagia prophylaxis in these higher-risk subsets, similar to patients treated for squamous cancers.
Collapse
Affiliation(s)
- Diane Wenhua Chen
- 1 Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Jan S Lewin
- 2 Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Li Xu
- 2 Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen Y Lai
- 2 Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - G Brandon Gunn
- 3 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Clifton David Fuller
- 3 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Abdallah S R Mohamed
- 3 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,4 Department of Clinical Oncology and Nuclear Medicine, Alexandria University, Alexandria, Egypt
| | - Aasheesh Kanwar
- 3 Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Erich M Sturgis
- 2 Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,5 Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Katherine A Hutcheson
- 2 Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|
3
|
Paleri V, Wood J, Patterson J, Stocken DD, Cole M, Vale L, Franks J, Guerrero-Urbano T, Donnelly R, Barclay S, Rapley T, Rousseau N. A feasibility study incorporating a pilot randomised controlled trial of oral feeding plus pre-treatment gastrostomy tube versus oral feeding plus as-needed nasogastric tube feeding in patients undergoing chemoradiation for head and neck cancer (TUBE trial): study protocol. Pilot Feasibility Stud 2016; 2:29. [PMID: 27965848 PMCID: PMC5154009 DOI: 10.1186/s40814-016-0069-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 05/17/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND There are 7000 new cases of head and neck squamous cell cancers (HNSCC) treated by the NHS each year. Stage III and IV HNSCC can be treated non-surgically by radio therapy (RT) or chemoradiation therapy (CRT). CRT can affect eating and drinking through a range of side effects with 90 % of patients undergoing this treatment requiring nutritional support via gastrostomy (G) or nasogastric (NG) tube feeding. Long-term dysphagia following CRT is a primary concern for patients. The effect of enteral feeding routes on swallowing function is not well understood, and the two feeding methods have, to date, not been compared to assess which leads to a better patient outcome. The purpose of this study is to explore the feasibility of conducting a randomised controlled trial (RCT) comparing these two options with particular emphasis on patient willingness to be randomised and clinician willingness to approach eligible patients. METHODS/DESIGN This is a mixed methods multicentre study to establish the feasibility of a randomised controlled trial comparing oral feeding plus pre-treatment gastrostomy versus oral feeding plus as required nasogastric tube feeding in patients with HNSCC. A total of 60 participants will be randomised to the two arms of the study (1:1 ratio). The primary outcome of feasibility is a composite of recruitment (willingness to randomise and be randomised) and retention. A qualitative process evaluation investigating patient, family and friends and staff experiences of trial participation will also be conducted alongside an economic modelling exercise to synthesise available evidence and provide estimates of cost-effectiveness and value of information. Participants will be assessed at baseline (pre-randomisation), during CRT weekly, 3 months and 6 months. DISCUSSION Clinicians are in equipoise over the enteral feeding options for patients being treated with CRT. Swallowing outcomes have been identified as a top priority for patients following treatment and this trial would inform a future larger scale RCT in this area to inform best practice. TRIAL REGISTRATION ISRCTN48569216.
Collapse
Affiliation(s)
- Vinidh Paleri
- Department of Otolaryngology–Head and Neck Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- University of Manchester, Manchester, UK
| | | | - Joanne Patterson
- City Hospitals Sunderland NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Deborah D. Stocken
- Clinical Trials and Biostatistics, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Mike Cole
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Health Economics, Newcastle University, Newcastle upon Tyne, UK
| | | | | | | | - Stewart Barclay
- Restorative Dentistry, Newcastle Dental Hospital, Newcastle upon Tyne, UK
| | - Tim Rapley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Nikki Rousseau
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
4
|
Zhang Z, Zhu Y, Ling Y, Zhang L, Wan H. Comparative effects of different enteral feeding methods in head and neck cancer patients receiving radiotherapy or chemoradiotherapy: a network meta-analysis. Onco Targets Ther 2016; 9:2897-909. [PMID: 27274283 PMCID: PMC4876095 DOI: 10.2147/ott.s101983] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Nasogastric tube (NGT) and percutaneous endoscopic gastrostomy were frequently used in the head and neck cancer patients when malnutrition was present. Nevertheless, the evidence was inclusive in terms of the choice and the time of tube placement. The aim of this network meta-analysis was to evaluate the comparative effects of prophylactic percutaneous endoscopic gastrostomy (pPEG), reactive percutaneous endoscopic gastrostomy (rPEG), and NGT in the head and neck cancer patients receiving radiotherapy or chemoradiotherapy. Databases of PubMed, Web of Science, and Elsevier were searched from inception to October 2015. Thirteen studies enrolling 1,631 participants were included in this network meta-analysis. The results indicated that both pPEG and NGT were superior to rPEG in the management of weight loss. pPEG was associated with the least rate of treatment interruption and nutrition-related hospital admission among pPEG, rPEG, and NGT. Meanwhile, there was no difference in tube-related complications. Our study suggested that pPEG might be a better choice in malnutrition management in the head and neck cancer patients undergoing radiotherapy or chemoradiotherapy. However, its effects need to be further investigated in more randomized controlled trials.
Collapse
Affiliation(s)
- Zhihong Zhang
- Department of Nursing, Shanghai Proton and Heavy Ion Center, Tongji University School of Medicine, Shanghai, People's Republic of China; Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yu Zhu
- Department of Nursing, Shanghai Proton and Heavy Ion Center, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Yun Ling
- Department of Human Resource, Shanghai Proton and Heavy Ion Center, Shanghai, People's Republic of China
| | - Lijuan Zhang
- Department of Nursing, Shanghai Proton and Heavy Ion Center, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Hongwei Wan
- Department of Nursing, Shanghai Proton and Heavy Ion Center, Tongji University School of Medicine, Shanghai, People's Republic of China
| |
Collapse
|
5
|
Hoffmann M, Saleh-Ebrahimi L, Zwicker F, Haering P, Schwahofer A, Debus J, Huber PE, Roeder F. Long term results of postoperative Intensity-Modulated Radiation Therapy (IMRT) in the treatment of Squamous Cell Carcinoma (SCC) located in the oropharynx or oral cavity. Radiat Oncol 2015; 10:251. [PMID: 26637471 PMCID: PMC4670508 DOI: 10.1186/s13014-015-0561-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 11/27/2015] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND To report our long-term results with postoperative intensity-modulated radiation therapy (IMRT) in patients suffering from squamous-cell carcinoma (SCC) of the oral cavity or oropharynx. METHODS Seventy five patients were retrospectively analyzed. Median age was 58 years and 84 % were male. 76 % of the primaries were located in the oropharynx. Surgery resulted in negative margins (R0) in 64 % of the patients while 36 % suffered from positive margins (R1). Postoperative stages were as follows: stage 1:4 %, stage 2:9 %, stage 3:17 %, stage 4a:69 % with positive nodes in 84 %. Perineural invasion (Pn+) and extracapsular extension (ECE) were present in 7 % and 29 %, respectively. All patients received IMRT using the step-and-shoot approach with a simultaneously integrated boost (SIB) in 84 %. Concurrent systemic therapy was applied to 53 patients, mainly cisplatin weekly. RESULTS Median follow-up was 55 months (5-150). 13 patients showed locoregional failures (4 isolated local, 4 isolated neck, 5 combined) transferring into 5-year-LRC rates of 85 %. Number of positive lymph nodes (n > 2) and presence of ECE were significantly associated with decreased LRC in univariate analysis, but only the number of nodes remained significant in multivariate analysis. Overall treatment failures occurred in 20 patients (9 locoregional only, 7 distant only, 4 combined), transferring into 3-and 5-year-FFTF rates of 77 % and 75 %, respectively. The 3-and 5-year-OS rates were 80 % and 72 %, respectively. High clinical stage, high N stage, number of positive nodes (n > 2), ECE and Pn1 were significantly associated with worse FFTF and OS in univariate analysis, but only number of nodes remained significant for FFTF in multivariate analysis. Maximum acute toxicity was grade 3 in 64 % and grade 4 in 1 %, mainly hematological or mucositis/dysphagia. Maximum late toxicity was grade 3 in 23 % of the patients, mainly long-term tube feeding dependency. CONCLUSION Postoperative IMRT achieved excellent LRC and good OS with acceptable acute and low late toxicity rates. The number of positive nodes (n > 2) was a strong prognostic factor for all endpoints in univariate and the only significant factor for LRC and FFTF in multivariate analysis. Patients with feeding tubes due to postoperative complications had an increased risk for long-term feeding tube dependency.
Collapse
Affiliation(s)
- M Hoffmann
- Clinical Cooperation Unit Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany. .,Department of Radiation Oncology, University Hospital of Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany.
| | - L Saleh-Ebrahimi
- Department of Radiation Oncology, University Hospital of Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany.
| | - F Zwicker
- Clinical Cooperation Unit Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - P Haering
- Department of Radiation Physics, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - A Schwahofer
- Department of Radiation Physics, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - J Debus
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany. .,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - P E Huber
- Clinical Cooperation Unit Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany. .,Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
| | - F Roeder
- Clinical Cooperation Unit Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany. .,Department of Radiation Oncology, University Hospital of Munich (LMU), Marchioninistr. 15, 81377, Munich, Germany.
| |
Collapse
|
6
|
Sachdev S, Refaat T, Bacchus ID, Sathiaseelan V, Mittal BB. Age most significant predictor of requiring enteral feeding in head-and-neck cancer patients. Radiat Oncol 2015; 10:93. [PMID: 25896830 PMCID: PMC4404131 DOI: 10.1186/s13014-015-0408-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 04/13/2015] [Indexed: 01/26/2023] Open
Abstract
Background A significant number of patients treated for head and neck squamous cell cancer (HNSCC) undergo enteral tube feeding. Data suggest that avoiding enteral feeding can prevent long-term tube dependence and disuse of the swallowing mechanism which has been linked to complications such as prolonged dysphagia and esophageal constriction. We examined detailed dosimetric and clinical parameters to better identify those at risk of requiring enteral feeding. Methods One hundred patients with advanced stage HNSCC were retrospectively analyzed after intensity-modulated radiation therapy (IMRT) to a median dose of 70 Gy (range: 60-75 Gy) with concurrent chemotherapy in nearly all cases (97%). Patients with significant weight loss (>10%) in the setting of severely reduced oral intake were referred for placement of a percutaneous endoscopic gastrostomy (PEG) tube. Detailed DVH parameters were collected for several structures. Univariate and multivariate analyses using logistic regression were used to determine clinical and dosimetric factors associated with needing enteral feeding. Dichotomous outcomes were tested using Fisher’s exact test and continuous variables between groups using the Wilcoxon rank-sum test. Results Thirty-three percent of patients required placement of an enteral feeding tube. The median time to tube placement was 25 days from start of treatment, after a median dose of 38 Gy. On univariate analysis, age (p = 0.0008), the DFH (Docetaxel/5-FU/Hydroxyurea) chemotherapy regimen (p = .042) and b.i.d treatment (P = 0.040) (used in limited cases on protocol) predicted need for enteral feeding. On multivariate analysis, age remained the single statistically significant factor (p = 0.003) regardless of other clinical features (e.g. BMI) and all radiation planning parameters. For patients 60 or older compared to younger adults, the odds ratio for needing enteral feeding was 4.188 (p = 0.0019). Conclusions Older age was found to be the most significant risk factor for needing enteral feeding in patients with locally advanced HNSCC treated with multimodal treatment. Pending further validation, this would support maximizing early nutritional guidance, targeted supplementation, and symptomatic support for older adults (>60) undergoing chemoradiation. Such interventions and others (e.g. swallowing therapy) could possibly delay or minimize the use of enteral feeding, thereby helping avoid tube dependence and tube-associated long-term physiologic consequences.
Collapse
Affiliation(s)
- Sean Sachdev
- Department of Radiation Oncology, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 251 E. Huron Street LC-178, Chicago, IL, 60611, USA.
| | - Tamer Refaat
- Department of Radiation Oncology, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 251 E. Huron Street LC-178, Chicago, IL, 60611, USA. .,Department of Clinical Oncology, Alexandria University, Alexandria, Egypt.
| | - Ian D Bacchus
- Department of Radiation Oncology, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 251 E. Huron Street LC-178, Chicago, IL, 60611, USA.
| | - Vythialinga Sathiaseelan
- Department of Radiation Oncology, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 251 E. Huron Street LC-178, Chicago, IL, 60611, USA.
| | - Bharat B Mittal
- Department of Radiation Oncology, Northwestern University Robert H. Lurie Comprehensive Cancer Center, 251 E. Huron Street LC-178, Chicago, IL, 60611, USA.
| |
Collapse
|
7
|
Verma V, Liu J, Eschen L, Danieley J, Spencer C, Lewis JS, Diaz J, Piccirillo JF, Adkins DR, Nussenbaum B, Thorstad WL, Gay HA. Pre-radiotherapy feeding tube identifies a poor prognostic subset of postoperative p16 positive oropharyngeal carcinoma patients. Radiat Oncol 2015; 10:8. [PMID: 25572866 PMCID: PMC4333178 DOI: 10.1186/s13014-014-0314-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 12/18/2014] [Indexed: 12/16/2022] Open
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. Conclusion 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.
Collapse
Affiliation(s)
- Vivek Verma
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA.
| | - Jingxia Liu
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA.
| | - Laura Eschen
- Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Campus Box 8224, St. Louis, 63110-6311, Missouri, USA.
| | - Jonathan Danieley
- Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Campus Box 8224, St. Louis, 63110-6311, Missouri, USA.
| | - Christopher Spencer
- Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Campus Box 8224, St. Louis, 63110-6311, Missouri, USA.
| | - James S Lewis
- Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA. .,Otolaryngology Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA.
| | - Jason Diaz
- Otolaryngology Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA.
| | - Jay F Piccirillo
- Otolaryngology Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA.
| | - Douglas R Adkins
- Medical Oncology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Brian Nussenbaum
- Otolaryngology Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA.
| | - Wade L Thorstad
- Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Campus Box 8224, St. Louis, 63110-6311, Missouri, USA.
| | - Hiram A Gay
- Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Campus Box 8224, St. Louis, 63110-6311, Missouri, USA.
| |
Collapse
|
8
|
Locher JL, Bonner JA, Carroll WR, Caudell JJ, Allison JJ, Kilgore ML, Ritchie CS, Tajeu GS, Yuan Y, Roth DL. Patterns of prophylactic gastrostomy tube placement in head and neck cancer patients: a consideration of the significance of social support and practice variation. Laryngoscope 2013; 123:1918-25. [PMID: 23401235 PMCID: PMC3655092 DOI: 10.1002/lary.24022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 12/10/2012] [Accepted: 01/07/2013] [Indexed: 11/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS The purpose of this study was to examine factors associated with prophylactic placement of feeding tubes in head and neck cancer patients receiving radiation therapy as a part of treatment using multilevel models that account for patient-, physician-, and institution-level sources of variation. STUDY DESIGN A retrospective analysis using binary logistic regression and hierarchical linear models was run to evaluate independent predictors of prophylactic feeding tube placement. METHODS Surveillance, Epidemiology, and End Results-Medicare data were used. Head and neck cancer patients diagnosed with locoregionally advanced stage disease from 2000 to 2005 were included in this study (N = 8,306). RESULTS Across all models, prophylactic gastrostomy tube placement was found to be more likely in patients who had cancer of the larynx or oropharynx compared with those with cancer of the nasopharynx or oral cavity; who had regional instead of local cancer; who did not receive surgery as a part of treatment, but did receive chemotherapy; and who were divorced, separated, or widowed. Additionally, although practice variation was observed to occur, its overall contribution in predicting prophylactic gastrostomy tube placement was minimal. CONCLUSIONS As health care enters an era of patient-centered care, further investigation of the potential role of social support (or lack of social support) in influencing treatment decisions of head and neck cancer patients and providers is warranted.
Collapse
Affiliation(s)
- Julie L Locher
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Langmore S, Krisciunas GP, Miloro KV, Evans SR, Cheng DM. Does PEG use cause dysphagia in head and neck cancer patients? Dysphagia 2011; 27:251-9. [PMID: 21850606 DOI: 10.1007/s00455-011-9360-2] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 07/19/2011] [Indexed: 10/17/2022]
Abstract
Percutaneous endoscopic gastrostomy (PEG) use is common in patients who undergo radiotherapy (RT) for head and neck cancer to maintain weight and nutrition during treatment. However, the true effect of PEG use on weight maintenance and its potential impact on long-term dysphagia outcomes have not been adequately studied. This retrospective study looked at swallowing-related outcomes among patients who received prophylactic PEG vs. those who did not, and among patients who maintained oral diets vs. partial oral diets vs. those who were nil per os (NPO). Outcomes were assessed at the end of RT and at 3, 6, and 12 months post RT. A comprehensive review of patients' medical charts for a 6-year period yielded 59 subjects with complete data. Results showed no difference in long-term percent weight change between the prophylactic PEG patients vs. all others, or between patients who, during RT, had oral diets vs. partial oral diets vs. NPO. However, those who did not receive prophylactic PEGs and those who maintained an oral or a partial oral diet during RT had significantly better diet outcomes at all times post RT. Dependence on a PEG may lead to adverse swallowing ability in post-irradiated head and neck cancer patients possibly due to decreased use of the swallowing musculature.
Collapse
Affiliation(s)
- Susan Langmore
- Otolaryngology Department, Boston University Medical Center, 820 Harrison Ave., Boston, MA 02118, USA.
| | | | | | | | | |
Collapse
|
10
|
Argiris A, Heron DE, Smith RP, Kim S, Gibson MK, Lai SY, Branstetter BF, Posluszny DM, Wang L, Seethala RR, Dacic S, Gooding W, Grandis JR, Johnson JT, Ferris RL. Induction docetaxel, cisplatin, and cetuximab followed by concurrent radiotherapy, cisplatin, and cetuximab and maintenance cetuximab in patients with locally advanced head and neck cancer. J Clin Oncol 2010; 28:5294-300. [PMID: 21079141 DOI: 10.1200/jco.2010.30.6423] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE We incorporated cetuximab, a chimeric monoclonal antibody against the epidermal growth factor receptor (EGFR), into the induction therapy and subsequent chemoradiotherapy of head and neck cancer (HNC). PATIENTS AND METHODS Patients with locally advanced HNC, including squamous and undifferentiated histologies, were treated with docetaxel 75 mg/m2 day 1, cisplatin 75 mg/m2 day 1, and cetuximab 250 mg/m2 days 1, 8, and 15 (after an initial loading dose of 400 mg/m2), termed TPE, repeated every 21 days for three cycles, followed by radiotherapy with concurrent cisplatin 30 mg/m2 and cetuximab weekly (XPE), and maintenance cetuximab for 6 months. Quality of life (QOL) was assessed using Functional Assessment of Cancer Therapy-Head and Neck. In situ hybridization (ISH) for human papillomavirus (HPV), immunohistochemistry for p16, and fluorescence ISH for EGFR gene copy number were performed on tissue microarrays. RESULTS Of 39 enrolled patients, 36 had stage IV disease and 23 an oropharyngeal primary. Acute toxicities during TPE included neutropenic fever (10%) and during XPE, grade 3 or 4 oral mucositis (54%) and hypomagnesemia (39%). With a median follow-up of 36 months, 3-year progression-free survival and overall survival were 70% and 74%, respectively. Eight patients progressed in locoregional sites, three in distant, and one in both. HPV positivity was not associated with treatment efficacy. No progression-free patient remained G-tube dependent. The H&N subscale QOL scores showed a significant decrement at 3 months after XPE, which normalized at 1 year. CONCLUSION This cetuximab-containing regimen resulted in excellent long-term survival and safety, and warrants further evaluation in both HPV-positive and -negative HNC.
Collapse
Affiliation(s)
- Athanassios Argiris
- University of Pittsburgh Medical Center Cancer Pavilion, 5th Floor, Pittsburgh, PA 15232, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|