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

• Published in: European archives of oto-rhino-laryngology Vol. 274; no. 10; pp. 3741 - 3749
• Main Authors: Vangelov, Belinda, Smee, Robert I.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2017
• Subjects: Adult; Aged; Australia; Chemoradiotherapy - adverse effects; Chemoradiotherapy - methods; Enteral Nutrition - methods; Female; Head and Neck; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - therapy; Head and Neck Surgery; Humans; Intubation, Gastrointestinal - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Neurosurgery; Oropharyngeal Neoplasms - pathology; Oropharyngeal Neoplasms - therapy; Otorhinolaryngology; Prognosis; Retrospective Studies; Time-to-Treatment; Weight Loss; Oropharynx cancer; Head and neck cancer; Nutrition; Reactive feeding tubes; Prophylactic feeding tubes
• ISSN: 0937-4477; 1434-4726
• DOI: 10.1007/s00405-017-4681-x

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.