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Original Investigation |

Risk Factors for Percutaneous Endoscopic Gastrostomy Tube Placement During Chemoradiotherapy for Oropharyngeal Cancer

Tobin Strom, MD1; Andy M. Trotti, MD1; Julie Kish, MD2; Nikhil G. Rao, MD1; Judith McCaffrey, MD3; Tapan A. Padhya, MD3; Hui-Yi Lin, PhD4; William Fulp, MS4; Jimmy J. Caudell, MD, PhD1
[+] Author Affiliations
1Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
2Department of Medical Oncology, Moffitt Cancer Center, Tampa, Florida
3Department of Otolaryngology, Moffitt Cancer Center, Tampa, Florida
4Department of Biostatistics, Moffitt Cancer Center, Tampa, Florida
JAMA Otolaryngol Head Neck Surg. 2013;139(11):1242-1246. doi:10.1001/jamaoto.2013.5193.
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Importance  Patients with oropharyngeal squamous cell carcinoma undergoing chemoradiotherapy may require percutaneous endoscopic gastrostomy (PEG) tube placement because of dehydration or significant weight loss.

Objectives  To determine the need for the reactive placement of a PEG tube during chemoradiotherapy for oropharyngeal cancer and to identify patient or tumor factors associated with reactively requiring the placement of a PEG tube.

Design, Setting, and Participants  Single-institution retrospective review of 297 patients treated with intensity-modulated radiation therapy and concurrent chemotherapy for oropharyngeal squamous cell carcinoma between May 1, 2004, and June 30, 2012, with a minimum follow-up period of 3 months.

Exposure  Placement of a PEG tube.

Main Outcomes and Measures  Logistic regression analysis was used to identify independent risk factors associated with symptomatic requirement for the reactive placement of a PEG tube.

Results  In total, 128 patients did not receive a prophylactic PEG tube within 10 days of initiation of chemoradiotherapy. Fifteen of 128 patients (11.7%) required the reactive placement of a PEG tube during or within 3 months of chemoradiotherapy. The median time to PEG tube removal was 3.3 months, and 14 of 15 patients had their PEG tube removed at the last follow-up analysis. Independent risk factors for PEG tube placement included the following: accelerated irradiation fractionation (odds ratio, 4.3; 95% CI, 1.1-16.5; P = .04), a tumor T classification of 3 or higher (odds ratio, 3.5; 95% CI, 1.0-11.9; P = .04), a cumulative cisplatin dose of 200 mg/m2 or higher (odds ratio, 6.7; 95% CI, 1.2-36.7; P = .03), and a body mass index (calculated as weight in kilograms divided by height in meters squared) of less than 25 (odds ratio, 5.8; 95% CI, 1.4-23.9; P = .02).

Conclusions and Relevance  Although the overall risk is low, a body mass index of less than 25, accelerated irradiation fractionation, a tumor T classification of 3 or higher, and a cumulative cisplatin dose of 200 mg/m2 or higher are associated with symptomatic need for the reactive placement of a PEG tube in patients with oropharyngeal cancer.

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Figure.
Conditional Inference Tree for Risk Subgroups Regarding the Reactive Placement of a Percutaneous Endoscopic Gastrostomy Tube

Patients at the lowest risk of receiving a percutaneous endoscopic gastrostomy tube had a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) of 25 or higher and were treated with conventional radiation therapy, while patients treated with accelerated irradiation fractionation were at the highest risk of reactively requiring the placement of a percutaneous endoscopic gastrostomy tube.

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