A multi‐institution pooled analysis of gastrostomy tube dependence in patients with oropharyngeal cancer treated with definitive intensity‐modulated radiotherapy

BACKGROUND Severe swallowing dysfunction necessitating enteral support is a well known late sequela of nonsurgical therapy for oropharyngeal cancer, but its incidence after intensity‐modulated radiotherapy has not been quantified comprehensively outside of small single‐institution series. METHODS This was a multi‐institution, institutional review board‐approved, retrospective study. Consecutive patients with oropharyngeal squamous cell carcinoma who had received definitive intensity‐modulated radiotherapy from 1998 to 2011 were identified from 3 academic centers. RESULTS In total, 2315 patients were included. The American Joint Committee on Cancer staging distribution was as follows: stage I, 2.1%; stage II, 4.4%; stage III, 14.7%; and stage IV, 77.3%. Among 1459 patients (63%) who received a gastrostomy tube (g‐tube), placement was prophylactic in 52% and reactive in 48%. Among patients with stage III and IV disease, 58% received concurrent chemotherapy. The median follow‐up was 43.7 months (range, 0.1‐164 months). The g‐tube dependence rate was 7% at 1 year and 3.7% at 2 years. Among 1238 patients with stage III and IV disease who received concurrent chemotherapy, the 1‐year and 2‐year rates of g‐tube dependence were 8.6% and 4.4%, respectively. The 1‐year g‐tube dependence rate was 5% for patients with stage I and II disease; 5.2% for patients with stage III and IV, T1‐T2/N0‐N2 disease; and 10.1% for patients with stage III and IV, T3‐T4 or N3 disease. On multivariate analysis, advanced age (odds ratio [OR], 1.066; P <.001), greater number of smoking pack‐years (OR, 1.008; P =.04), advanced N‐category (OR, 1.13; P =.049), and receipt of cytotoxic chemotherapy (OR, 2.26; P =.02) were predictive of g‐tube dependence at 1 year. CONCLUSIONS This multi‐institution series of 2315 patients treated at 3 institutions demonstrates that modern nonsurgical therapy for oropharyngeal cancer is associated with a low rate of long‐term g‐tube dependence. Cancer 2015;121:294–301 . © 2014 American Cancer Society .