Anna C H Willemsen1, Annemieke Kok2, Sander M J van Kuijk3, Laura W J Baijens4, Remco de Bree5, Lot A Devriese6, Frank J P Hoebers7, Roy I Lalisang8, Annemie M W J Schols9, Chris H J Terhaard10, Ann Hoeben8. 1. Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center +, the Netherlands; GROW-School of Oncology and Developmental Biology, Maastricht University Medical Center +, the Netherlands; Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center +, the Netherlands. 2. Department of Dietetics, University Medical Center Utrecht, the Netherlands. Electronic address: a.kok-4@umcutrecht.nl. 3. Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center +, the Netherlands. 4. GROW-School of Oncology and Developmental Biology, Maastricht University Medical Center +, the Netherlands; Department of Otorhinolaryngology, Head & Neck Surgery, Maastricht University Medical Center +, the Netherlands. 5. Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, the Netherlands. 6. Department of Medical Oncology, University Medical Center Utrecht, the Netherlands. 7. GROW-School of Oncology and Developmental Biology, Maastricht University Medical Center +, the Netherlands; Department of Radiation Oncology, MAASTRO Clinic, Maastricht, the Netherlands. 8. Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center +, the Netherlands; GROW-School of Oncology and Developmental Biology, Maastricht University Medical Center +, the Netherlands. 9. Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center +, the Netherlands. 10. Department of Radiotherapy, University Medical Center Utrecht, the Netherlands.
Abstract
BACKGROUND & AIMS: Chemoradiation and bioradiation (CRT/BRT) for locally advanced head and neck squamous cell carcinoma (LAHNSCC) often comes with high toxicity rates, interfering with oral intake and leading to temporary tube feeding (TF) dependency. High-quality scientific evidence for indicators of prophylactic gastrostomy insertion is not available. The aim of this retrospective cohort study was to develop a prediction model to identify patients who need prophylactic gastrostomy insertion, defined as the expected use of TF for at least four weeks. METHODS: Four-hundred-fifty LAHNSCC patients receiving CRT/BRT with curative intent between 2013 and 2016 were included in the study. Primary outcome was TF-dependency for four weeks or longer. Patient, tumor, and treatment characteristics were extracted from the medical records and their effects on the use of TF were analyzed using univariable and multivariable analysis. The prediction model was internally validated using bootstrapping techniques. RESULTS: Sixty-five percent (294/450 patients) required TF for four weeks or longer. Variables included in the model were: body mass index and adjusted diet at start of CRT/BRT, percentage weight change at baseline, World Health Organization performance status, tumor subsite, TNM-classification, CRT/BRT, mean radiation dose on the contralateral submandibular and parotid gland. The corrected Area Under the Curve after internal validation was 72.3%, indicating good discriminative properties of the prediction model. CONCLUSIONS: We developed and internally validated a prediction model that is intended to estimate TF-dependency for at least four weeks in LAHNSCC patients treated with CRT/BRT. This model can be used as a tool to support personalized decision making on prophylactic gastrostomy insertion.
BACKGROUND & AIMS: Chemoradiation and bioradiation (CRT/BRT) for locally advanced head and neck squamous cell carcinoma (LAHNSCC) often comes with high toxicity rates, interfering with oral intake and leading to temporary tube feeding (TF) dependency. High-quality scientific evidence for indicators of prophylactic gastrostomy insertion is not available. The aim of this retrospective cohort study was to develop a prediction model to identify patients who need prophylactic gastrostomy insertion, defined as the expected use of TF for at least four weeks. METHODS: Four-hundred-fifty LAHNSCC patients receiving CRT/BRT with curative intent between 2013 and 2016 were included in the study. Primary outcome was TF-dependency for four weeks or longer. Patient, tumor, and treatment characteristics were extracted from the medical records and their effects on the use of TF were analyzed using univariable and multivariable analysis. The prediction model was internally validated using bootstrapping techniques. RESULTS: Sixty-five percent (294/450 patients) required TF for four weeks or longer. Variables included in the model were: body mass index and adjusted diet at start of CRT/BRT, percentage weight change at baseline, World Health Organization performance status, tumor subsite, TNM-classification, CRT/BRT, mean radiation dose on the contralateral submandibular and parotid gland. The corrected Area Under the Curve after internal validation was 72.3%, indicating good discriminative properties of the prediction model. CONCLUSIONS: We developed and internally validated a prediction model that is intended to estimate TF-dependency for at least four weeks in LAHNSCC patients treated with CRT/BRT. This model can be used as a tool to support personalized decision making on prophylactic gastrostomy insertion.
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