HPV+ Oropharyngeal Cancer and Feeding Tube Use With Chemoradiation

Abstract

We sought to determine factors predicting feeding tube use and quantify measures of tube use in HPV-positive oropharyngeal cancer (OPC) patients treated with chemoradiation. Retrospective, single-institutional analysis of patient-, disease-, and treatment-specific factors of HPV+ OPC. Eligible patients had pathologic confirmation of HPV+ OPC and received chemoradiation. Patients with unknown HPV/p16 status, <3-month follow-up, or metastatic disease were excluded. Between 2007-2015, 29 patients (28 male, 1 female) were eligible for present analysis. All patients had HPV+ OPC, median age 60 years (40-87). PEG Tubes were placed in 62% of patients for a median length of 163 days (74-1268). Seven, 17, and 5 patients had clinical stage III, IVA, and IVB cancer, with 29%, 65%, and 100% requiring PEG tube, respectively. Forty-five percent of patient with primary site resection required a PEG tube. One-hundred percent of patients initiated adjuvant chemotherapy, 17 completed their course. Fourteen, 9, 2, and 4 patients received Cisplatin (Cis) every 3rd week, IV Cis weekly, Cetuximab therapy, or other, respectively. All 18 patients with a PEG tube had Cisplatin (Table 1). All patients completed the intended course of radiation therapy (RT), with a dose range of 60-70 Gy. In pounds, -14.85 and -13, were the median values of weight change from RT start to completion for those with and without PEG tubes, respectively. Weight change from the end of RT to the 4-6-week follow-up was +1.6 and +3.1 for those with and without PEG tubes, respectively. Overall, weight change from the beginning of RT to 4-6 weeks post-RT was -17.2 and -20.7 in those with and without PEG tubes, respectively. No patient had a prior history of head/neck cancer. Of the 19 patients with a smoking history, 10 needed a PEG, 8 of which had 10+ pack-years. Of the 16 patients hospitalized 1+ times, 12 required a PEG (75%). In contrast, of the 13 patients not hospitalized, 6 required a PEG (46%). Three patients died, one treatment related, another unknown cause, and one from disease. Two patients are currently alive with disease. The other 24 patients are alive without disease. Small numbers limited statistical analysis to descriptive statistics. In HPV+ OPC treated with chemoradiation, 62% of patients require PEG tube for a median 163 days. Factors that may predispose patients to an increased likelihood and prolonged use of PEG tubes include higher clinical stage, cisplatin, 10+ pack-years, and hospitalization.Abstract 304; Table 1Clinical AJCC Stage (v7)Cis q3rd week (100mg/m2x3 days)Cis IV weekly (for 6-7 weeks)Stage 3Stage 4aStage 4bMedian # of Days with PEG Tube144178222148171.5 Open table in a new tab