Premium
Impact of feeding tube choice on severe late dysphagia after definitive chemoradiotherapy for human papillomavirus–negative head and neck cancer
Author(s) -
Ward Matthew C.,
Bhateja Priyanka,
Nwizu Tobenna,
Kmiecik Joann,
Reddy Chandana A.,
Scharpf Joseph,
Lamarre Eric D.,
Burkey Brian B.,
Greskovich John F.,
Adelstein David J.,
Koyfman Shlomo A.
Publication year - 2016
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.24157
Subject(s) - dysphagia , medicine , percutaneous endoscopic gastrostomy , head and neck cancer , gastrostomy , chemoradiotherapy , feeding tube , surgery , oropharyngeal dysphagia , gastroenterology , cancer , peg ratio , finance , economics
Background Severe late dysphagia is common after chemoradiotherapy for cancers of the larynx and oropharynx. Options for reduction of severe late dysphagia are limited for human papillomavirus (HPV)‐negative patients. In this study, the role of feeding tube choice in severe late dysphagia is investigated. Methods Patients disease‐free after chemoradiotherapy for HPV‐negative cancers of the laryngopharynx who received a feeding tube on‐treatment were identified. The incidence of severe late dysphagia after reactive nasogastric (R‐NG), proactive or reactive percutaneous gastrostomy (P‐PEG or R‐PEG) was assessed using log‐rank and Cox analyses. Results Seventy‐eight patients received a feeding tube on‐treatment and remained disease‐free. Median follow‐up was 64 months. The 5‐year incidence of severe late dysphagia was 30.8% in the R‐NG cohort ( n = 36), 56.4% in the R‐PEG ( n = 17; p = .193), and 60.9% in the P‐PEG ( n = 25; p = .016) cohorts. On multivariate analysis, percutaneous gastrostomy (PEG) feeding was independently associated with an increased rate of severe late dysphagia. Conclusion R‐NG use during chemoradiotherapy is associated with less severe late dysphagia and is preferred over PEG. © 2015 Wiley Periodicals, Inc. Head Neck 38 : E1054–E1060, 2016