Belinda Vangelov1, Damian P Kotevski2, Janet R Williams3, Robert I Smee4. 1. Department of Radiation Oncology, The Nelune Comprehensive Cancer Centre, The Prince of Wales Hospital, Randwick, New South Wales, Australia. Electronic address: belinda.vangelov@health.nsw.gov.au. 2. Department of Radiation Oncology, The Nelune Comprehensive Cancer Centre, The Prince of Wales Hospital, Randwick, New South Wales, Australia. 3. Department of Radiation Oncology, The Nelune Comprehensive Cancer Centre, The Prince of Wales Hospital, Randwick, New South Wales, Australia; University of New South Wales Clinical Teaching School, The Prince of Wales Hospital, Randwick, New South Wales, Australia. 4. Department of Radiation Oncology, The Nelune Comprehensive Cancer Centre, The Prince of Wales Hospital, Randwick, New South Wales, Australia; University of New South Wales Clinical Teaching School, The Prince of Wales Hospital, Randwick, New South Wales, Australia; Department of Radiation Oncology, Tamworth Base Hospital, Tamworth, NSW, Australia.
Abstract
OBJECTIVES: It has been well established that patients with oropharyngeal carcinoma are at high nutritional risk, with significant weight loss and tube feeding common. Human papillomavirus (HPV)-associated disease has led to a change in the "typical" presentation and nutritional profile of this population. The aim of our study was to determine whether the need for a feeding tube, and weight loss during radiotherapy (RT) in patients with oropharyngeal carcinoma differed with HPV status. MATERIALS AND METHODS: Patients who received curative RT ± chemotherapy from January 2011 to January 2016 were included (n = 100). We retrospectively evaluated feeding tube use and timing of insertion (prophylactic vs reactive), percentage weight loss during RT and the prevalence of critical weight loss (CWL) ≥5%. RESULTS: HPV-positive patients had significantly higher weight loss during RT compared to the rest of the cohort (8.4% vs 6.1%, 95%CI 0.8-3.9, p = 0.003). CWL was observed in 86% and in a higher proportion with HPV-positive disease (93%, p = 0.011). Conditional probability modelling analysis revealed, with 74% accuracy, concurrent chemoradiotherapy and HPV-positive status were predictors of CWL when comparing HPV-positive patients to HPV-negative (96%, p = 0.001 and 98%, p = 0.012 respectively). More HPV-positive patients required feeding tubes (n = 43, 63%, p = 0.05), most being reactive (n = 27, 63%). All patients with reactive tubes experienced CWL. CONCLUSION: The high incidence of CWL in patients with HPV-positive oropharyngeal carcinoma is of concern. Tube feeding continues to be a necessary nutritional intervention in this population and predicting who will require a tube is challenging. Larger, prospective cohort studies are required.
OBJECTIVES: It has been well established that patients with oropharyngeal carcinoma are at high nutritional risk, with significant weight loss and tube feeding common. Human papillomavirus (HPV)-associated disease has led to a change in the "typical" presentation and nutritional profile of this population. The aim of our study was to determine whether the need for a feeding tube, and weight loss during radiotherapy (RT) in patients with oropharyngeal carcinoma differed with HPV status. MATERIALS AND METHODS:Patients who received curative RT ± chemotherapy from January 2011 to January 2016 were included (n = 100). We retrospectively evaluated feeding tube use and timing of insertion (prophylactic vs reactive), percentage weight loss during RT and the prevalence of critical weight loss (CWL) ≥5%. RESULTS:HPV-positive patients had significantly higher weight loss during RT compared to the rest of the cohort (8.4% vs 6.1%, 95%CI 0.8-3.9, p = 0.003). CWL was observed in 86% and in a higher proportion with HPV-positive disease (93%, p = 0.011). Conditional probability modelling analysis revealed, with 74% accuracy, concurrent chemoradiotherapy and HPV-positive status were predictors of CWL when comparing HPV-positive patients to HPV-negative (96%, p = 0.001 and 98%, p = 0.012 respectively). More HPV-positive patients required feeding tubes (n = 43, 63%, p = 0.05), most being reactive (n = 27, 63%). All patients with reactive tubes experienced CWL. CONCLUSION: The high incidence of CWL in patients with HPV-positive oropharyngeal carcinoma is of concern. Tube feeding continues to be a necessary nutritional intervention in this population and predicting who will require a tube is challenging. Larger, prospective cohort studies are required.
Authors: Rebecca T Karsten; Najiba Chargi; Lisette van der Molen; Rob J J H van Son; Remco de Bree; Abrahim Al-Mamgani; Jan P de Boer; Frans J M Hilgers; Michiel W M van den Brekel; Ludi E Smeele; Martijn M Stuiver Journal: Eur Arch Otorhinolaryngol Date: 2021-05-27 Impact factor: 2.503
Authors: Nigel J Anderson; James E Jackson; Morikatsu Wada; Michal Schneider; Michael Poulsen; Maureen Rolfo; Maziar Fahandej; Hui Gan; Vincent Khoo Journal: J Med Radiat Sci Date: 2019-08-06