Dramatic Reduction in the Need for Feeding Tube Use in Human Pappilomavirus–Positive Oropharyngeal Cancer in the Intensity Modulated Radiation Therapy Era

Abstract

Human papillomavirus (HPV)-positive oropharyngeal cancer patients have improved cancer-related outcomes and appear to tolerate treatment with less morbidity. We hypothesize that feeding tube rates are decreasing selectively in this population. Patients treated with definitive chemoradiation (CRT; >66 Gy) for head and neck squamous cell cancer between 2007 and 2014 were included in this institutional review obard–approved study. Patients were treated with 3-dimensional CRT in the earlier years of the study and intensity modulated radiation therapy (IMRT) since 2009. All patients were treated with concurrent chemotherapy, typically cisplatin based (90%), or with cetuximab (10%). At our institution, prophylactic feeding tubes (FTs) are typically avoided, and reactive FTs are used if patients lose excessive amounts of weight or experience dehydration requiring admission. Analysis of Variance trend test was performed to identify the significance of temporal trends in the use of FTs over time. Of 421 patients included in this study, 194 (46%) had an FT placed. Of these, corpaks were used in 84%, while percutaneous endoscopic gastrostomy (PEG) tubes were used in the remainder. HPV-positive oropharyngeal cancers comprised 280 pts (66%), while the remainder included pts with cancers of the larynx (15%), HPV-negative oropharynx (11%), hypopharynx (4.5%), and nasopharynx (2.5%). Median age was 58 years, 84% were male, and 76% had a smoking history (median pack-years, 27). Median dose of RT was 72 Gy (68-78 Gy). Rates of FT use steadily declined for patients with HPV-positive oropharynx cancer, with a highly significant decrease from 80% in 2007 to 24% in 2014 (R2=0.931; P=.0001). This pattern was not seen for all other (HPV-negative) patients (see Table 1). Median duration of FT use was 60 days and did not differ by HPV status. Overall, only 40 pts (10%) had an FT beyond 90 days following IMRT, and only 15 patients (3.6%) had an FT at last follow-up. FT use has become the exception rather than the rule in patients with HPV-positive oropharyngeal cancer undergoing definitive CRT. Routine FT use should be avoided in this population.Abstract 179; Table 1YearHPV+ oropharynx feeding tubeAll other feeding tube200780%34.37%200859.25%24.24%200953.33%32.43%201054%52.94%201129.26%61.53%201241.86%46.66%201325%38.46%201423.91%21.87% Open table in a new tab