Matthew C Ward1, Priyanka Bhateja2, Tobenna Nwizu3, Joann Kmiecik4, Chandana A Reddy1, Joseph Scharpf5, Eric D Lamarre5, Brian B Burkey5, John F Greskovich1, David J Adelstein3, Shlomo A Koyfman1. 1. Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio. 2. Department of Hospital Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio. 3. Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio. 4. Speech Pathology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio. 5. Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio.
Abstract
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.
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.
Authors: Heather M Starmer; Rina Abrams; Kimberly Webster; Jennifer Kizner; Beth Beadle; F Christopher Holsinger; Harry Quon; Jeremy Richmon Journal: Dysphagia Date: 2017-09-30 Impact factor: 3.438
Authors: William Su; Jerry Liu; Brett A Miles; Eric M Genden; Krzysztof J Misiukiewicz; Marshall Posner; Vishal Gupta; Richard L Bakst Journal: PLoS One Date: 2016-12-08 Impact factor: 3.240