Abstract
Background and purposeTo determine if dose and/or dose-volume parameters to anatomic swallowing structures are predictive of gastrostomy tube (PEG) dependence from chemotherapy-intensity modulated radiotherapy (IMRT) in locally advanced head and neck cancer (LAHNC). Methods and materialsA retrospective study was performed on 141 consecutive patients with LAHNC (squamous cell) treated with definitive chemoIMRT with weekly concurrent carboplatin and paclitaxel. Late dysphagia was assessed by length of PEG requirement. Analysis of IMRT dose was retrospectively performed for critical swallowing structures. ResultsApproximately 62% of patients required PEG, the majority placed during treatment. Mean and median time for PEG was 7.7 and 4.4months respectively (range 1.4–43.8). Only IMRT dose to the inferior constrictor was significantly associated with length of PEG. Mean dose (of individual mean doses) was 47Gy for prolonged PEG use versus 41Gy for PEG ⩽12months. V40 to the inferior constrictor also correlated with PEG >12months (p=0.02) with a mean V40 of 48% versus 41% for PEG ⩽12months. ConclusionsIMRT dose to the inferior constrictor correlated with persistent dysphagia requiring prolonged PEG use. Maintaining mean inferior constrictor dose to ⩽41Gy and V40 to ⩽41% may help minimize gastrostomy tube dependence.
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