Clinical and dosimetric factors associated with a prolonged feeding tube requirement in patients treated with chemoradiotherapy (CRT) for head and neck cancers

Abstract

Increased radiation dose to the PCs is associated with a higher risk of a prolonged FT need. Dose sparing of the PC muscles may reduce this risk.

Management of patients treated with chemoradiotherapy for head and neck cancer without prophylactic feeding tubes: The University of Pittsburgh experience

“…Our group recently reported on the potential significance of radiation dose to the pharyngeal constrictor muscles as a parameter that correlates with longer duration of G-tube use. 10 The objective of this retrospective review was to determine the utilization, associated complications, and duration of G-tube placement in patients who underwent curative CRT for locally advanced head and neck cancer and to identify potential risk factors that may be associated with prolonged G-tube dependence in this patient population. This is an analysis enriched by additional patients and clinical data and longer patient follow-up that follows our earlier report that focused on radiation dose aspects of treatment.…”

“…This is an analysis enriched by additional patients and clinical data and longer patient follow-up that follows our earlier report that focused on radiation dose aspects of treatment. 10 …”

“…However, there was an association with total radiation dose to the pharyngeal constrictors and G-tube dependence beyond 6 months post-CRT. 10 A potential limitation of the present analysis is the variability of CRT regimen used. The type of CRT regimen may affect the severity of mucositis during treatment, and thus, G-tube placement incidence and duration.…”

Therapeutic Potential of Adipose Stem Cells in Tissue Repair of Irradiated Skeletal Muscle in a Rabbit Model

“…For instance, difficulty in opening the mouth and trismus were evoked by radiation-induced injury to masticatory muscles in the patients with nasopharyngeal neoplasms and oropharyngeal neoplasms (Krasin et al, 2012;Marcus and Tishler, 2010). The exposure of the pharyngeal constrictor muscle to high-dose irradiation resulted in dysphagia and even longterm use of tube feeding in patients with head and neck cancer (Caudell et al, 2010;Gokhale et al, 2010). Phonatory and swallowing dysfunction was evoked by radiation-induced thyroarytenoid injury (Tedla et al, 2012).…”

Optimising nutrition support in patients with head and neck cancer

“…Several studies document the predictive factors for long term tube feeding, or gastrostomy dependency, such as tumour sites (Caudell et al, 2010;Ishiki et al, 2012), tumour stage (Akst et al, 2004;Avery et al, 2008;Gokhale et al, 2010;Kornguth et al, 2005;Lawson et al, 2009), treatment modality (Avery et al, 2008;Kornguth et al, 2005;Lango et al, 2010), radiotherapy treatment fields and dose (Caudell et al, 2010;Gokhale et al, 2010;Li et al, 2009;Sanguineti et al, 2011), smoking (Li et al, 2009), age (Kornguth et al, 2005;Lango et al, 2010;Lawson et al, 2009), and pre-treatment weight loss or low body mass index (BMI) (Lango et al, 2010;McRackan et al, 2008). These types of clinical factors are often considered for the prediction of patients who may benefit from PGT placement (Brown et al, 2013b;Jack et al, 2012;Wood, 2005), as they are anticipated to require a feeding tube for longer than four weeks and thus a gastrostomy is the most suitable long term feeding device (Arends et al, 2006).…”