Clinical predictors for reactive tube feeding in patients with advanced oropharynx cancer receiving radiotherapy ± chemotherapy

Abstract

Enteral feeding is often required for nutrition support in head and neck cancer patients when oral intake is inadequate. When to initiate the insertion of a feeding tube continues to be a debated issue in our institution. We investigated the use of reactive feeding tubes (RFTs) in patients with advanced stage oropharynx cancer (OPC). Data were retrospectively collected on 131 patients who had radiotherapy (RT) ± chemotherapy from 2005 to 2015. Predictors for RFT insertion were investigated. Weight loss during RT was compared between those with RFT versus prophylactic tubes (PFTs) versus no tube, and survival outcomes evaluated. RFTs were more likely to be needed in patients who had bilateral neck node irradiation (p = 0.001) and concurrent chemoradiotherapy (CRT) (p = 0.038). Patients with RFTs had significantly higher mean percentage weight loss during RT (9.5 ± 3.4%) (p < 0.001) when compared to those with a PFT (5.2 ± 4.7%) and those with no tube (5.4 ± 3.1%). No difference was seen in 5-year survival rates in patients who did not have a feeding tube to those who required a RFT. RFT use is frequent in OPC, although difficult to predict. CRT and bilateral neck node irradiation were found to be associated with the need for the insertion of a feeding tube during RT. These patients also experience significantly higher weight loss, therefore, prophylactic tubes may need to be considered more often in this population.

Prediction model for tube feeding dependency during chemoradiotherapy for at least four weeks in head and neck cancer patients: A tool for prophylactic gastrostomy decision making

“…Potential predictors were preselected based on clinical reasoning and evidence of previous research. We preselected patient's age [34e38], gender [29,37], tobacco [39], and alcohol use, body mass index (BMI) [40,41], weight loss [42,43], and texture modified diet at baseline (as indicator for dysphagia) [29,37,42], in which baseline is considered right before treatment initiation, World Health Organization performance status (WHO PS) [44e46], tumor subsite [35,37,41,47,48], tumor stage [35e37, 40,42,43,47e51], nodal stage [24,36,37,39,41] (TNM-classification [52]), human papilloma virus (HPV) in situ hybridization (ISH) or P16 expression (surrogate biomarker of HPV infection) of the tumor [34], primary or adjuvant setting [41,44,47], type of radiosensitizing systemic therapy (platinum-based chemotherapy or immunotherapy) [35,39,42e44,47], bilateral neck irradiation [24,49,53], mean RT dose on the contralateral submandibular [44] and parotid gland [43,44].…”

Nutritional Support in Head and Neck Radiotherapy Patients Considering HPV Status

“…Enteral nutrition (EN) is often required for nutrition support in HNC patients when oral intake is inadequate [ 39 ]. It may be used in order to prevent malnutrition and dehydration in patients undergoing CRT prior to the beginning of treatment (prophylactic or preventive nutrition) or in order to improve NS in already malnourished patients during oncological treatment (reactive nutrition).…”

“…Vangelov et al [ 39 ] retrospectively investigated the use of reactive feeding tubes (RFTs) in 131 patients with advanced OPC undergoing CRT. Predictors for RFT insertion were investigated.…”

“…Also, in these patients, significantly higher weight loss was more frequently noted. Therefore, in the authors’ opinion, prophylactic tubes may need to be considered more often in this patient group [ 39 ].…”

Efeito do atendimento nutricional intensivo em pacientes com câncer de cabeça e pescoço submetidos à radioterapia

“…85 Ao longo do tratamento oncológico, a desnutrição aumenta consideravelmente nos pacientes com CCP. 81,[86][87][88] As sequelas nutricionais resultantes da radioterapia, por exemplo, ocorrem por efeitos diretos da radiação nos tecidos neoplásicos e normais e estão relacionadas ao local do tumor e às regiões irradiadas. Entre as toxicidades da RT em pacientes com câncer de cabeça e pescoço, que afetam a ingestão oral, estão mudança no sabor, secreções pegajosas, mucosite, xerostomia, odinofagia, trismo, disfagia entre outros.…”