Gastrostomy Tube Dependence Research Articles

Obesity and Survival After Immune Checkpoint Inhibition for Head and Neck Squamous Cell Carcinoma

For patients treated with immune checkpoint inhibitors (ICIs), recent data suggest that obesity has a beneficial effect on survival outcomes in various cancer types. Reports on this association in head and neck cancer are limited. To compare overall survival (OS) to 5 years and functional outcomes in patients with head and neck squamous cell carcinoma (HNSCC) treated with ICIs based on pretreatment body mass index (BMI). This retrospective population-based cohort study used data obtained from the TriNetX Global Collaborative Network database to identify patients with HNSCC who received ICI treatment between January 1, 2012, and December 31, 2023, resulting in a total of 166 patients (83 with BMI of 20.0-24.9 [normal BMI] and 83 with BMI of ≥30.0 [obesity BMI]) after propensity score matching (PSM) for pretreatment medical comorbidities and oncologic staging. Normal BMI vs obesity BMI. Overall survival and functional outcomes (dysphagia, tracheostomy dependence, and gastrostomy tube dependence) were measured to 5 years after ICI treatment and compared between patients with obesity BMI and normal BMI. Additional analyses compared OS and functional outcomes in the cohort with normal BMI and cohorts with overweight BMI (25.0-29.9) and underweight BMI (<20.0). Among the 166 patients included in the PSM analysis (112 men [67.1%]; mean [SD] age, 62.9 [15.4] years), obesity BMI was associated with significantly improved OS at 6 months (hazard ratio [HR], 0.54 [95% CI, 0.31-0.96]), 3 years (HR, 0.56 [95% CI, 0.38-0.83]), and 5 years (HR, 0.62 [95% CI, 0.44-0.86]) after ICI treatment, compared with patients with normal BMI. Obesity BMI was also associated with decreased risk of gastrostomy tube dependence at 6 months (odds ratio [OR], 0.41 [95% CI, 0.21-0.80]), 1 year (OR, 0.41 [95% CI, 0.21-0.78]), 3 years (OR, 0.35 [95% CI, 0.18-0.65]), and 5 years (OR, 0.34 [95% CI, 0.18-0.65]). Obesity was also associated with decreased risk for tracheostomy dependence at 1 year (OR, 0.52 [95% CI, 0.28-0.90]), 3 years (OR, 0.45 [95% CI, 0.45-0.90]), and 5 years (OR, 0.45 [95% CI, 0.45-0.90]). There were no differences in rates of dysphagia or immune-related adverse events between cohorts at any points. Using population-level data for patients with HNSCC treated with ICIs, these results suggest that having obesity was associated with improved 6-month, 3-year, and 5-year OS compared with having normal BMI. Additionally, obesity was associated with decreased gastrostomy and tracheostomy tube dependence compared with normal BMI. Further investigation is required to understand the mechanism of these findings.

The association of sex and gender with disordered eating behavior in youth with hypertension

AbstractFemales have higher disordered eating behavior (DEB) prevalence versus males in the general population, but no data exist in adolescents with hypertension (HTN). Our objective was to determine the association of sex and gender with DEB prevalence in adolescents with HTN disorders. This was a secondary analysis of data from a prospective cross‐sectional study of adolescents aged 11–18 years with HTN disorders. We excluded patients with diabetes mellitus, kidney failure/transplantation, or gastrostomy tube dependence. We collected data via abstraction and surveys, including the SCOFF questionnaire. Our exposures were self‐reported sex and gender, and our outcome was SCOFF ≥ 2/5. We used bivariate generalized linear models. Of 74 participants, 61% identified as male, and 39% identified as female. DEB prevalence was 28%: 20% in males and 41% in females by sex and gender. Females had double the DEB risk versus males by sex (risk ratio [RR]: 2.07, 95% confidence level [CL]: 0.9996–4.28) and gender (RR: 2.02, 95% CL: 0.98–4.18), but both p &gt; 0.05. Among adolescents with HTN disorders, while females had double the risk of screening positive for DEB versus males by sex and gender, the results were not statistically significant. Adolescents with HTN may benefit from routine DEB screening, especially those that identify as female, but larger studies are needed.

Expanded clinical phenotype spectrum correlates with variant function in SCN2A-related disorders.

SCN2A-related disorders secondary to altered function in the voltage-gated sodium channel Nav1.2 are rare, with clinically heterogeneous expressions that include epilepsy, autism and multiple severe to profound impairments and other conditions. To advance understanding of the clinical phenotypes and their relationship to channel function, 81 patients (36 female, 44%, median age 5.4 years) with 69 unique SCN2A variants were systematically phenotyped and their Nav1.2 channel function systematically assessed. Participants were recruited through the FamileSCN2A Foundation. Primary phenotype (epilepsy of neonatal onset, n = 27; infant onset, n = 18; and later onset n = 24; and autism without seizures, n = 12) was strongly correlated with a non-seizure severity index (P = 0.002), which was based on presence of severe impairments in gross motor, fine motor, communication abilities, gastrostomy tube dependence and diagnosis of cortical visual impairment and scoliosis. Non-seizure severity was greatest in the neonatal-onset group and least in the autism group (P = 0.002). Children with the lowest severity indices were still severely impaired, as reflected by an average Vineland Adaptive Behavior composite score of 49.5 (>3 standard deviations below the norm-referenced mean of the test). Epileptic spasms were significantly more common in infant-onset (67%) than in neonatal (22%) or later-onset (29%) epilepsy (P = 0.007). Primary phenotype was also strongly correlated with variant function (P < 0.0001); gain-of-function and mixed function variants predominated in neonatal-onset epilepsy, shifting to moderate loss of function in infant-onset epilepsy and to severe and complete loss of function in later-onset epilepsy and autism groups. Exploratory cluster analysis identified five groups, representing: (i) primarily later-onset epilepsy with moderate loss-of-function variants and low severity indices; (ii) mostly infant-onset epilepsy with moderate loss-of-function variants but higher severity indices; and (iii) late-onset and autism only, with the lowest severity indices (mostly zero) and severe/complete loss-of-function variants. Two exclusively neonatal clusters were distinguished from each other largely on non-seizure severity scores and secondarily on variant function. The relationship between primary phenotype and variant function emphasizes the role of developmental factors in the differential clinical expression of SCN2A variants based on their effects on Nav1.2 channel function. The non-seizure severity of SCN2A disorders depends on a combination of the age at seizure onset (primary phenotype) and variant function. As precision therapies for SCN2A-related disorders advance towards clinical trials, knowledge of the relationship between variant function and clinical disease expression will be valuable for identifying appropriate patients for these trials and in selecting efficient clinical outcomes.

Elucidating survival and functional outcomes in patients with primary head and neck malignancies treated in academic versus community settings.

Differences in treatment outcomes between community or academic centers are incompletely understood. Retrospective review of head and neck cancer patients between 2010 and 2020 in a rural health region. Kaplan-Meier curves and log-rank tests were used to evaluate survival outcomes, along with bivariate and multivariable Cox proportional hazards models. Linear regression was used for functional outcomes of tracheotomy and gastrostomy tube dependence. Two hundred and forty-eight patients treated at an academic center were compared with 94 patients treated in community centers. In multivariable analysis, the risk of death (HR = 0.60, p = 0.019), and risk of recurrence were lower (HR = 0.29, p < 0.001) for patients treated in academic centers. Patients treated in community centers had longer gastrostomy tube dependence (p = 0.002). Our findings suggest that treatment at an academic center was associated with a lower risk of recurrence and shorter gastrostomy tube dependence compared to treatment in the community.

Assessment of Swallowing Function in Patients with Head and Neck Squamous Cell Carcinoma in High vs. Low Dose Cisplatin

Cisplatin-based therapies are standard-of-care for advanced-stage head and neck squamous cell carcinoma (HNSCC). Treatment regimens include 3 weeks of high-dose bolus cisplatin or 6–7 weeks of low-dose weekly cisplatin, both with concurrent radiation. The effects of cisplatin dosage on swallowing function warrant further study. A 237-patient cohort treated for HNSCC at a single center were studied retrospectively. Gastrostomy tube dependence served as the primary endpoint. Secondary endpoints included weight changes, esophageal stricture, and lymphedema. The primary/secondary outcomes were not statistically significant; however, ototoxicity and renal toxicity were significantly higher in the high-dose group. These findings add insight into cisplatin dose-based functional outcomes.

Early Celecoxib use in Patients with Traumatic Brain Injury.

Traumatic brain injury (TBI) can cause rapid brain inflammation. There is debate over the safety and efficacy of anti-inflammatory agents in its treatment. With a particular focus on cyclooxygenase 2 (COX2) selective inhibition, we sought to determine the impact of celecoxib versus no celecoxib treatment on outcomes in patients with TBI and compare these with outcomes associated with nonselective COX inhibition (ibuprofen) and corticosteroid (dexamethasone) treatment. This retrospective cohort study used TriNetX, a large publicly available global health research network, to gather clinical data extracted from the electronic medical records. Using International Classification of Diseases, Tenth Revision and pharmacy codes, we identified patients with TBI who were and were not treated with celecoxib, ibuprofen, and dexamethasone. Analysis was performed on propensity-matched and unmatched cohorts, which were matched on demographics, comorbidities, and neurological injuries. Our primary end point was 1-year survival. Secondary end points were ventilator and tracheostomy dependence, gastrostomytube placement, seizures, and craniotomy. After propensity score matching, a total of 1443 patients were identified in both the celecoxib and no celecoxib cohorts. Ninety-two (6.4%) patients in the celecoxib cohort died within 1year following TBI versus 145 (10.0%) in the no celecoxib cohort (odds ratio 0.61; 95% confidence interval 0.46-0.80; p = 0.0003). The 1-year survival rate was 96.1% in the celecoxib cohort versus 93.1% in the no celecoxib cohort (p < 0.0001). At the end of the 1-year period, celecoxib was associated with significantly lower gastrostomy tube dependence (p = 0.017), seizure activity (p = 0.027), and myocardial infarction (p = 0.021) compared with the control cohort. Ibuprofen was also associated with higher 1-year survival probability and lower rates of post-TBI complications. Dexamethasone was broadly associated with higher morbidity but was associated with higher 1-year survival probability compared with the no dexamethasone cohort. Early celecoxib and ibuprofen use within 5days post TBI was associated with higher 1-year survival probabilities and fewer complications. With emerging yet controversial preclinical evidence to suggest that COX inhibition improves TBI outcomes, this population-level study offers suggestive support for these drugs' clinical benefit, which should be pursued in prospective clinical studies.

Morbidity and mortality among neonates with esophageal atresia and/or tracheoesophageal fistula in the United States.

Although rare, esophageal atresia (EA) and/or tracheoesophageal fistula (TEF) can lead to severe morbidity and mortality. A known complication of EA and/or TEF repair is vocal fold motion impairment (VFMI). To characterize the prevalence of VFMI among repaired EA and/or TEF at a national level and to identify factors associated with in-patient mortality and common clinical endpoints in this population (tracheostomy and gastrostomy tube dependence). This is a retrospective cohort study of inpatient neonate admissions with EA and/or TEF in the 2016 Kids' Inpatient Database (KID). Patients with a history of EA and/or TEF were identified with ICD-10 codes. VFMI prevalence was assessed by observed frequencies and percentages. Clinical endpoints included gastrostomy (G-)tube placement, tracheostomy status, and inpatient mortality. Potential predictors of these three primary outcomes included cardiac anomalies, airway disorders, chromosomal anomalies, surgery within 24h of admission, prematurity, and low birthweight (LBW). Chi-squared analysis was performed between each parameter and the primary outcomes. Significant associations (p-value<0.05) were further assessed with multivariate logistic regression. Of 1062 neonates with history of EA and/or TEF, 24 (2.3%) had VFMI. Among this population, 27 patients underwent tracheostomies and 63 required G-tubes. There was a significantly higher likelihood of tracheostomy in patients with VFMI compared to patients without (16.7% versus 2.2%; p<0.01). After multivariate analysis, birthweight less than 1.5kg (BW<1.5kg; OR=2.5, 95% CI: 1.03-6.10), extreme prematurity (OR=7.5, 95% CI: 2.00-28.07), cardiac anomalies (OR=1.8, 95% CI: 1.01-3.04) and chromosomal anomalies (OR=4.2, 95% CI: 2.39-7.44) were significantly associated with in-hospital mortality. Bronchopulmonary dysplasia (BPD; OR=4.7, 95% CI: 1.73-12.78) and BW<1.5kg (OR=2.4, 95% CI: 1.05-5.49) were significant predictors for G-tube status. For tracheostomy, BPD (OR=15.8, 95% CI: 4.70-52.83) and subglottic stenosis (SS, OR=11.2, 95% CI: 1.85-68.02) remained significant predictors after multivariate regression. The national prevalence of VFMI among neonates following EA and/or TEF repair was 2.3% and was associated with an increased likelihood of tracheostomy in the KID 2016. Significant predictors of in-hospital mortality were cardiac anomalies, chromosomal anomalies, extreme prematurity, and BW<1.5kg. BPD and SS were significant predictors of tracheostomy, and BPD and BW<1.5kg were significant predictors for G-tube requirements.

Gastrostomy dependence following pharyngolaryngectomy: The effect of preoperative tube insertion.

The aim of this study is to investigate the impact of preoperative gastrostomy in patients undergoing pharyngolaryngectomy (PL) on gastrostomy tube dependence at 6 months postoperatively. A retrospective review of patients undergoing PL for laryngeal squamous cell carcinoma between 2005 and 2019 was performed. Parameters were collected and analyzed within the multivariate models. Ninety-three patients (82% male, mean age 63.4 [SD 9.4]) were included. Preoperative tube placement and pharyngocutaneous fistula (PCF) were associated with an increased likelihood of gastrostomy tube dependence at 6 months (odds ratio 6.43, CI 1.1-38.3, p = 0.041) after adjusting for multiple confounding factors. There was no difference in the incidence of delayed oral feeding, PCF, or hospital stay between the groups. Preoperative tube and PCF are associated with an increased likelihood of tube dependence at 6 months. Patients for preoperative tube insertion should be carefully selected and early oral feeding reintroduction should be encouraged.

Differences in Functional and Survival Outcomes Between Patients Receiving Primary Surgery vs Chemoradiation Therapy for Treatment of T1-T2 Oropharyngeal Squamous Cell Carcinoma

Due to lack of data from high-powered randomized clinical trials, the differences in functional and survival outcomes for patients with oropharyngeal squamous cell carcinoma (OPSCC) undergoing primary transoral robotic surgery (TORS) vs primary radiation therapy and/or chemoradiation therapy (RT/CRT) are unclear. To compare 5-year functional (dysphagia, tracheostomy dependence, and gastrostomy tube dependence) and survivorship outcomes in patients with T1-T2 OPSCC receiving primary TORS vs RT/CRT. This national multicenter cohort study used data from a global health network (TriNetX) to identify differences in functional and survival outcomes among patients with OPSCC who underwent primary TORS or RT/CRT in 2002 to 2022. After propensity matching, 726 patients with OPSCC met inclusion criteria. In the TORS group, 363 (50%) patients had undergone primary surgery, and in the RT/CRT group, 363 (50%) patients had received primary RT/CRT. Data analyses were performed from December 2022 to January 2023 using the TriNetX platform. Primary surgery with TORS or primary treatment with radiation therapy and/or chemoradiation therapy. Propensity score matching was used to balance the 2 groups. Functional outcomes were measured at 6 months, 1 year, 3 years, 5 years, and more than 5 years posttreatment and included dysphagia, gastrostomy tube dependence, and tracheostomy dependence according to standard medical codes. Five-year overall survivorship was compared between patients undergoing primary TORS vs RT/CRT. Propensity score matching allowed a study sample with 2 cohorts comprising statistically similar parameters with 363 (50%) patients in each. Patients in the TORS cohort had a mean (SD) age of 68.5 (9.9) vs 68.8 (9.7) years in RT/CRT cohort; 86% and 88% were White individuals, respectively; 79% of patients were men in both cohorts. Primary TORS was associated with clinically meaningful increased risk of dysphagia at 6 months (OR, 1.37; 95% CI, 1.01-1.84) and 1 year posttreatment (OR, 1.71; 95% CI, 1.22-2.39) compared with primary RT/CRT. Patients receiving surgery were less likely to be gastrostomy tube dependent at 6 months (OR, 0.46; 95% CI, 0.21-1.00) and 5 years posttreatment (risk difference, -0.05; 95% CI, -0.07 to -0.02). Differences in overall rates of tracheostomy dependence (OR, 0.97; 95% CI, 0.51-1.82) between groups were not clinically meaningful. Patients with OPSCC, unmatched for cancer stage or human papillomavirus status, who received RT/CRT had worse 5-year overall survival than those who underwent primary surgery (70.2% vs 58.4%; hazard ratio, 0.56; 95% CI, 0.40-0.79). This national multicenter cohort study of patients undergoing primary TORS vs primary RT/CRT for T1-T2 OPSCC found that primary TORS was associated with a clinically meaningful increased risk of short-term dysphagia. Patients treated with primary RT/CRT had an increased risk of short- and long-term gastrostomy tube dependence and worse 5-year overall survival than those who underwent surgery.

Prevalence and risk factors of disordered eating behavior in youth with hypertension disorders.

Adolescents with certain health conditions requiring lifestyle management, such as diabetes mellitus, have higher disordered eating behavior (DEB) risk than the general adolescent population, but DEB is underdiagnosed and can lead to adverse health consequences. In youth with other conditions requiring lifestyle counseling such as hypertension (HTN), DEB prevalence and associated risk factors are unknown. We hypothesized that youth with HTN disorders would have higher DEB prevalence than the general adolescent population, and that obesity, chronic kidney disease (CKD), and less specialized lifestyle counseling would be associated with higher DEB risk. Prospective cross-sectional study of youth aged 11-18years with HTN disorders. We excluded patients with diabetes mellitus, kidney failure or transplantation, or gastrostomy tube dependence. We collected data via surveys and electronic health record abstraction. We administered the validated SCOFF DEB screening questionnaire. We compared DEB prevalence using a one-sample z-test of proportions (p0 = 0.1) and estimated DEB risk by obesity, CKD, and lifestyle counseling source using multivariable generalized linear models. Of 74 participants, 59% identified as male, 22% as Black or African American, and 36% as Hispanic or Latino; 58% had obesity and 26% had CKD. DEB prevalence was 28% (95% CI 18-39%, p < 0.001). CKD was associated with higher DEB prevalence (adjusted RR 2.17, 95% CL 1.09 to 4.32), but obesity and lifestyle counseling source were not. DEB prevalence is higher in youth with HTN disorders and comparable to other conditions requiring lifestyle counseling. Youth with HTN disorders may benefit from DEB screening. A higher resolution version of the Graphical abstract is available as Supplementary information.

Changes in Medical Charges Following Intensive Multidisciplinary Intervention for Pediatric Gastrostomy Tube Dependence.

Intensive multidisciplinary intervention (IMI) is the most evidence-based approach to treat pediatric feeding disorders. The goal of this exploratory study was to assess changes in health care charges for patients with gastrostomy tube dependence following participation in IMI compared to a waitlist control. Medical charges were assessed for 9 families who participated in IMI compared to 6 control families on a multi-year waitlist for IMI. The IMI and control groups were compared on raw charges submitted as well as individual year-over-year changes in medical charges. The IMI group decreased health care charges by 71% on average in the year following IMI compared to the control group increasing charges by 22% over the same period. IMI also holds potential cost-savings in the year following treatment compared to children who do not receive treatment and adds to previous research focusing on long-term cost effectiveness of IMI.

Orbital Lipolysis.

HomeRadiologyVol. 307, No. 2 PreviousNext Reviews and CommentaryFree AccessImages in RadiologyOrbital LipolysisTuba Kalelioglu , Sohil H. PatelTuba Kalelioglu , Sohil H. PatelAuthor AffiliationsFrom the Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee St, 1st Floor, Charlottesville, VA 22903.Address correspondence to T.K. (email: [email protected]).Tuba Kalelioglu Sohil H. PatelPublished Online:Jan 24 2023https://doi.org/10.1148/radiol.221947MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In A 47-year-old man with a history of squamous cell carcinoma of the oral tongue, alcohol-induced chronic pancreatitis with gastrostomy tube dependence, and chronic diarrhea presented to the emergency department with altered mental status. The patient was cachectic, with a body mass index of 14.3 kg/m2.MRI of the brain demonstrated diffuse loss of expected fat signal intensity with T1-weighted imaging, including within the orbits, bone marrow, and subcutaneous scalp (Figure). This appearance is similar to a fat-saturated T1-weighted image; hence, it is called “pseudo fat-saturated” (1). It is due to excessive lipolysis and lipid peroxidation induced by cachexia from chronic malnutrition in the setting of anorexia nervosa or systemic cancer. Furthermore, endothelial injury results in edema and contrast enhancement in the involved areas, conspicuous in the postseptal orbit (2).Images in a 47-year-old man with cachectic state. (A) T1-weighted image before cachectic state for comparison shows expected normal high signal intensity of the orbital, scalp, and bone marrow fat. (B) Axial T1-weighted image without fat suppression shows lack of expected hyperintense fat in the orbits, subcutaneous scalp, and bone marrow. The imaging appearance mimics a fat-saturated T1-weighted image. The volume of subcutaneous fat in temporal regions is decreased. (C) Postcontrast T1-weighted image shows diffuse contrast enhancement of the affected areas secondary to increased vessel wall permeability. (D) Noncontrast CT scan shows increased attenuation in the retrobulbar fat, consistent with edema.Download as PowerPointOpen in Image Viewer Disclosures of conflicts of interest: T.K. No relevant relationships. S.H.P. No relevant relationships.

Survival and functional outcomes after total glossectomy with total laryngectomy: Case series from a high-volume tertiary institution

ObjectivesTotal glossectomy with total laryngectomy (TGTL) is indicated for some cases of advanced oral squamous cell carcinoma. However, this procedure is rarely performed, as quality of life outcomes are often considered poor. Consequently, few studies to date have reported survival and functional outcomes in patients undergoing TGTL. Here, we present the largest cases series to date of TGTL patients and provide relevant data on survival and functional outcomes. MethodsPatients met inclusion criteria if they underwent TGTL (concurrent or staged) indicated for head and neck squamous cell carcinoma. Patient demographics and disease characteristics, survival outcomes, functional oral intake scores, time to oral intake, gastrostomy tube dependence, and communication methods post-surgery were retrospectively extracted from the electronic medical record. ResultsSurvival in patients undergoing TGTL was poor. Most patients in this study were eventually approved for some oral intake of restricted consistencies but remained gastrostomy tube dependent for most of their nutritional needs. Baseline oral intake was suboptimal in most patients but often re-achieved approximately 12 months following surgery. Communication methods following surgery included writing, text-to-speech, and augmentative and alternative communication devices. ConclusionOur data provide new insights comparing survival and functional outcomes of patients undergoing TGTL. Additional investigation particularly on patient-perceived quality of life following TGTL is needed to better understand the risks and benefits for patients who are candidates for TGTL.

Factors Leading to Gastrostomy Tube and Tracheostomy Requirements in Patients Treated Initially With Radiotherapy and Salvaged With Surgery and Free Flap Reconstruction.

Patients with recurrent oropharyngeal cancer can achieve survival benefits from surgical salvage, and often require simultaneous free-flap reconstruction. Resection and reconstruction can impact function, leading to tube dependence. describe rates of tracheostomy and gastrostomy tube dependence after oropharyngeal resection and free flap after prior radiation. evaluate patient, tumor, and treatment factors associated with tube dependence. Retrospective, multi-institutional cohort study. Patients treated from 2003 to 2020. Average follow-up 21.4 months. Five tertiary care centers. Consecutive cohort of patients undergoing resection and simultaneous free-flap reconstruction for oropharyngeal squamous cell carcinoma after head and neck radiation. gastrostomy tube dependence and tracheostomy or tracheostoma 1 year after surgery. Univariable and multivariable logistic regression were performed to identify factors associated with dependence. 89 patients underwent oropharyngectomy and free-flap reconstruction; 18 (20%) underwent total laryngectomy as part of tumor extirpation. After surgery, 51 patients (57%) lived 12 months. Among patients alive at 12 months, 22 (43%) were at least partially-dependent on gastrostomy tube, and 15 (29%) had either tracheostomy or tracheostoma. On multivariable analysis, extensive glossectomy (OR 16.6, 95% CI 1.83-389, p=0.026) and total laryngectomy (OR 11.2, 95% CI 1.71-105, p=0.018) were associated with long-term gastrostomy tube. No factors were associated with long-term tracheostomy on multivariable analysis. Even among long-term survivors after salvage resection and free-flap reconstruction, rates of tube dependence are significant. This multi-institutional review is the largest such study to the date and may help inform shared decision-making. 4 Laryngoscope, 133:2141-2147, 2023.

Gastrostomy Tube Use in Head and Neck Cancer Survivors, Pre-Treatment Factors Supersede Treatment Intensification: A Second Analysis of RTOG 0129, RTOG 0522, and NRG/RTOG 1016

<h3>Purpose/Objective(s)</h3> Clinical and treatment factors that engender long-term gastrostomy tube (g-tube) dependence are poorly defined. We attempted to identify potential predictors. <h3>Materials/Methods</h3> All eligible patients treated on RTOG 0129, RTOG 0522, and NRG/RTOG 1016 were grouped according to treatment received: standard fractionation RT (3DSFX) + cisplatin (C), accelerated fractionation RT (3DAFX) + C, accelerated IMRT (AFX) + C, AFX + C + cetuximab (cetux) and AFX + cetux. G-tube rates were compared at baseline (pre-treatment), 6-months after radiation completion, and annually from years 1 to 9 post treatment. Time to g- tube placement was analyzed using Cox proportional hazards models for variables of interest. Additionally, a separate review was performed for patients with no g-tube at 3 years' post-treatment (survivors with acceptable post-treatment swallowing) to evaluate late g-tube placement. <h3>Results</h3> 2389 patients were identified, 1839 of which had oropharynx cancer (OPC). AFX+C was the most common management (n=843, 35%). The G-tube rate at treatment initiation was 14%. At one-year post-treatment the rate was 19% and at 9 years the number was 8%. The RTOG 0129 g-tube rate was significantly higher than that of later studies (RTOG 0522 HR 0.7, 0.6-0.8; NRG/RTOG1016 HR 0.85 (0.72-0.99). Patients treated with 3D regimens had significantly higher feeding tube rate at baseline, 6 months, 1 year, and 2 years post-treatment (3DSFX + C: 25%/45%/29%/13% and 3DAFX + C: 22%/41%/26%/17%, respectively) when compared to accelerated IMRT regimens (all time points p < 0.001). There was no difference in feeding tube rate between treatment groups from years 3 – 9. Among OPC patients the predictors of feeding tube placement were older age (HR 1.01, 1.00-1.02), T4 primary (1.3, 1.1-1.6) and >10 pack year smoking history (HR 1.2, 1.0-1.4). Treatment regimen, tumor location, and p16-status did not affect g-tube placement. Among all patients, predictors of g-tube placement were older age (HR 1.01, 1.01-1.02); T4 primary (HR 1.3, 1.2-1.5), AJCC 7^th ed N2c/N3 (1.3, 1.1-1.6); and >10 pack year smoking history (HR 1.2, 1.0-1.3). At 3 years there were 989 patients alive with follow-up who never required a gastrostomy tube. Of the 249 of these patients with 9 years' follow-up the g-tube rate was 6%. From univariable model predictors of feeding tubes placed more than 5 years after treatment completion were T3 category, T4 category, >10 pack years smoking, non-tonsil or tongue base primary, and p16-negative tumors. <h3>Conclusion</h3> G-tube rates were highest in patients managed with 3DCRT on RTOG 0129; utilization has significantly decreased over time. Radiation acceleration treatment intensification does not increase g-tube use during treatment or survivorship. Predictors of feeding tube use are increasing age, T4 primary tumors and >10 pack year smoking history.

Chronic Dysphagia in Patients Treated with Head and Neck Intensity-Modulated Radiotherapy: Incidence, Risk Factors and Implications

<h3>Purpose/Objective(s)</h3> Late dysphagia after head and neck radiotherapy is an important driver of poor quality-of-life. We aimed to identify risk factors associated with long-term gastrostomy tube (g-tube) dependence in patients with head and neck squamous cell carcinoma treated with definitive or postoperative radiotherapy. <h3>Materials/Methods</h3> A retrospective cohort analysis of patients with head and neck squamous cell carcinoma treated with definitive or adjuvant intensity-modulated radiotherapy was performed. Patients with locoregional or distance recurrence were excluded from the analysis. G-tube dependence was used as a surrogate marker for late dysphagia, and its placement and removal from initial presentation to last follow-up was tracked. The risk of g-tube dependence from years one through five was calculated, and factors associated with 1- and 2-year g-tube use were analyzed with multivariable logistic regression. <h3>Results</h3> Our analytic cohort consisted of 421 survivors with head and neck squamous cell cancer treated from 2001 to 2018. A total of 210 patients required a g-tube with 80, 124, and 13 g-tubes placed before, during, and after radiotherapy, respectively. The median follow-up of the entire cohort was 4 years (IQR 3-5), with 314, 222, and 124 patients at-risk in years 3, 4 and 5. The Kaplan-Meier g-tube dependence rate at 1 and 2 years after radiotherapy were 11% and 6%, respectively, and 5%, 3% and 2% at three, four and five years, respectively. On multivariable regression analysis on 1-year g-tube dependence, history of depression or anxiety (odds ratio, OR, 95% confidence interval, CI, 3.86 [1.47, 10.3]), clinical T3/T4 stage (3.75 [1.60, 9.30]), clinical N2 or N3 stage (3.66 [1.03, 14.4]), baseline swallowing impairment to both solids and liquids (11.1 [3.22, 41.8]), and intra-treatment weight loss greater than 10% (3.75 [1.51, 9.81]) were significant predictors. A total of 390 patients had adequate follow-up data for the 2-year analysis. On multivariable analysis, age (1.06 [1.00, 1.14]), clinical N2/N3 stage (15.2 [1.72, 393]), and baseline swallowing impairment to both solids and liquids (95% confidence interval: 41.5 [5.59, 551]) were significantly associated with increased odds of 2-year g-tube dependence. Definitive vs. adjuvant treatment was not significantly associated with 1 or 2-year g-tube dependence. Out of 22 patients with g-tube dependence at two years after radiotherapy, only six (27%) patients had a known tube removal in the years to follow. <h3>Conclusion</h3> The overall incidence of prolonged g-tube dependence is low but not trivial, and the vast majority of patients with dependence at two years remained dependent permanently. We have identified a cohort at highest risk for long-term use, for whom early interventions should be targeted since late removal becomes progressively more unlikely.

Abstract P090: Prevalence And Risk Factors Of Disordered Eating Behavior In Youth With Hypertension

Background: Eating disorders in adolescents are increasing in prevalence and have adverse health consequences, but remain underdiagnosed. Patients with medical conditions that require lifestyle management, such as obesity and diabetes mellitus, have higher disordered eating behavior (DEB) risk (20–39%) than the general adolescent population (10%). Patients with CKD might also be at increased DEB risk. In youth with other conditions requiring lifestyle counseling—such as HTN—DEB prevalence and associated risk factors are unknown. Objective: Estimate DEB prevalence in youth with HTN compared to the general adolescent population and investigate whether obesity, CKD, or less specialized lifestyle counseling source are associated with higher DEB risk. Design/Methods: Prospective cross-sectional study of youth aged 11–18 years with HTN. We excluded patients with diabetes mellitus, kidney failure or transplantation, or gastrostomy tube dependence. We collected data via surveys and electronic health record abstraction. We administered the validated SCOFF DEB screening questionnaire wherein a score ≥2/5 is positive. We compared DEB prevalence using a one-sample z-test of proportions (p 0 =0.1) and estimated DEB risk by obesity, CKD, or lifestyle counseling using multivariable generalized linear models. Results: Of 74 participants, 59% (44/74) identified as male gender, 22% (16/74) as Black or African American, and 36% (27/74) as Hispanic; 58% (43/74) had obesity and 26% (19/74) had CKD. DEB prevalence was 28% (95% CI 18–39%, p &lt;0.001). CKD was associated with higher DEB prevalence (adjusted RR 2.17, 95% CL 1.09 to 4.32), but obesity and lifestyle counseling source were not. Conclusions: DEB prevalence is higher in youth with HTN and comparable to that reported in other conditions requiring lifestyle counseling. Concurrent CKD is associated with more than double the risk of DEB in this population. Youth with HTN may benefit from routine DEB screening.

Abstract P046: The Association Of Sex And Gender With Disordered Eating Behavior In Youth With Hypertension

Background: DEB (disordered eating behavior) prevalence in adolescents has been increasing steadily. Females generally have a higher prevalence compared to males in the general population, but data do not exist in adolescents with HTN, a condition that requires lifestyle counseling and is more common in males. Finally, the difference in the risk of DEB conferred between sex, a biological construct, and gender, a self-identified construct, is characterized poorly, especially in youth with HTN. Objective: Determine the association of sex and gender with DEB prevalence in adolescents with HTN disorders. Hypothesis: Females will have a higher prevalence of screening positive for DEB compared to males regardless of if defined by sex or gender. Design/Methods: This was a secondary analysis of a prospective cross-sectional study of adolescents aged 11-18 years with HTN disorders. We excluded patients with diabetes mellitus, kidney failure or transplantation, or gastrostomy tube dependence. We collected data via electronic health record abstraction and surveys, including the validated SCOFF DEB screening questionnaire, with a score ≥2/5 as positive, as well as self-reported sex, defined as assigned at birth, and gender, defined as that with which the participant identifies. We compared DEB prevalence by sex and gender using bivariate generalized linear models; our directed acyclic graph identified no variables in the adjustment set. Results: Of 74 participants, 59% (44/74) identified as male and 41% (30/74) identified as female. One participant whose sex was male declined to answer the gender question. DEB prevalence overall was 28% (21/74); it was 20% (9/45) in males and 41% (12/29) in females by both sex and gender. Females had double the risk of DEB compared to males, when defined by sex (adjusted RR 2.07, 95% CL 0.9996 to 4.28), or gender (adjusted RR 2.02, 95% CL 0.98 to 4.18). However, our findings did not meet statistical significance at p &lt;0.05. Conclusions: Among adolescents with HTN disorders, females had double the risk of screening positive for DEB compared to males by both sex and gender. Adolescents with HTN may benefit from routine DEB screening, especially those that identify as female.

Impact of dosimetric factors on long-term percutaneous enteral gastrostomy (PEG) tube dependence in head and neck cancer patients after (chemo)radiotherapy—results from a prospective randomized trial

Purpose/objectiveTo analyze dose–volume histogram (DVH)-derived data on the exposure of organs at risk with impact on long-term percutaneous enteral gastrostomy (PEG) tube dependence in head and neck cancer patients at 6 and 12 months after definitive or adjuvant (chemo)radiotherapy.Materials and methodsSixty-one patients were prospectively treated with (chemo)radiotherapy. Prophylactic or reactive gastrostomy tube placement was performed in 41 (67.2%) patients. Dose–volume histogram parameters were obtained for the swallowing apparatus.ResultsMedian follow-up time was 25 (2–34) months. Overall survival was shorter in patients with inlying PEG tubes at 6 and 12 months (log rank p = 0.038 and p = 0.017) after therapy completion. The estimated median time of tube dependency was 6 (95% confidence interval: 2–14) months. After 6 months, 46.5% of patients were tube dependent. After 12 months, this estimated proportion fell to 31.5%. For both time points, the volume to the larynx (in %) receiving at least 50 Gy (larynx V50Gy) exceeding 53% was predictive for long-term tube feeding (6 months: p = 0.041 and 12 months: p = 0.042) being an independent predictor during multivariable analysis. There was no clinical feature influencing tube dependence after 12 months.ConclusionLong-term gastrostomy dependence was found to be strongly associated with an exposure of laryngeal structures (specifically, V50Gy ≥ 53%) during radiotherapy. Consequently, the avoidance of supraglottic as well as glottic structures is warranted.

The impact of dynamic tongue reconstruction using functional muscle transfer: A retrospective review of 94 cases with functional outcome analysis for various glossectomy defects

The aim of this study was to evaluate the functional outcomes of dynamic tongue reconstruction in various types of glossectomy defects. A retrospective review of patients who underwent tongue reconstruction following cancer resection was performed. Patients were divided into two groups by the type of procedure: dynamic reconstruction using motor-innervated free flaps and conventional reconstruction with fasciocutaneous free flaps. Demographics, including patient and tumor characteristics, and surgical factors, including the type of glossectomy and flap, were investigated. Functional outcomes were compared through quantitative assessment of tongue movement, speech capacity, videofluoroscopic barium swallow, and percutaneous endoscopic gastrostomy (PEG) tube dependency. 94 patients were enrolled in this study. The conventional reconstruction was performed in 52 patients and dynamic reconstruction was performed in 42 patients. Overall, the dynamic group showed improved swallowing capacity (videofluoroscopic swallowing scale, mean ± standard deviation, dynamic group, 3.24 ± 0.79, versus conventional group, 2.88 ± 1.08; p = 0.07). No significant differences in tongue motion and speech outcomes were noted between the groups. In multivariate logistic analysis controlling of various confounders, the dynamic reconstruction was significantly related to improved swallowing outcomes (adjusted odds ratio, 0.148; 95% confidence interval 0.03–0.725; p = 0.018). Dynamic reconstruction was not significantly related to the rate of PEG tube dependency. Within the limitations of the study, it seems that the dynamic tongue reconstruction using motor innervated free flaps can improve swallowing outcome by reproducing the original sling action of tongue musculature and preserving the tongue volume.