Retrospective Analysis of Individuals with Mucosal Head and Neck Cancers Treated with Adjuvant/Definitive Radiotherapy and Factors Contributing to Feeding Tube Placement: A Single Institutional Review

Summary: Radiotherapy (RT) + chemotherapy is an integral part in the management of individuals with mucosal head and neck cancers in both the definitive and adjuvant setting. While undergoing RT, patients will experience symptoms which negatively impact their oral intake resulting in decreased weight and overall nutritional status. Percutaneous endoscopic gastronomy (PEG) tubes are placed to help with nutrition when symptoms dictate. However, PEG tubes have their own associated risks with concerns on the late effects on swallowing. We sought to identify the specific factors at our institution that result in placement of PEG tubes. Retrospective review of individuals treated at a single institution, with either adjuvant or definitive radiotherapy, for primary mucosal head and neck cancers from January 1st through December 31st, 2022. Patient-specific, cancer-specific, dosimetric, and PEG tube information was summarized and compared. Subsequently, a univariate and multivariate analyses (MVA) were performed to identify factors related to the placement of PEG tubes while undergoing RT. A total of 90 individuals were treated with either adjuvant or definitive intent for mucosal head and neck cancer. 26 individuals did not undergo PEG tube placement, 30 had reactive PEG tubes, and 34 had prophylactic PEG tubes. The overall PEG tube rate was 71% (64/90) with 47% (30/64) of PEG tubes placed being reactive. If not planned to have PEG tubes placed prophylactically, 53.5% (30/56) had reactive PEG tube placement. On MVA of individuals without prophylactic PEG tubes and those receiving reactive PEG tubes, significant clinical factors that influenced PEG tube placement included pre-treatment dysphagia (P=0.0316) and bilateral neck involvement (P=0.0148). Significant dosimetric factors which influenced PEG tube placement included mean dose to the cervical esophagus (P=0.0177) with mean dose to the combined parotid gland approaching significance (P=0.0633). We identified several factors that correlate with PEG tube placement which included pre-treatment dysphagia, bilateral neck involvement, and dose to the cervical esophagus. Further prospective evaluation will be needed to validate these factors to develop tools that would better predict which individuals require PEG tube placement as well as patients in need of continued optimization. We are working on a prospective multi-disciplinary approach to decrease the utilization of PEG tubes. Phoebus Sun Cao (he/him/his), MD (Presenting Author) - SUNY Upstate; Brian Goodrich, RT(T), MBA (Co-Author) - SUNY Upstate; Tarun Podder, PhD (Co-Author) - SUNY Upstate; Kathryn Krawczyk, MS, RDN, CDN, CNSC (Co-Author) - SUNY Upstate; Weidong Li, PhD (Co-Author) - SUNY Upstate; Kathryn Spinek, NP (Co-Author) - SUNY Upstate; Karna Sura, MD (Co-Author) - SUNY Upstate; Seung Shin Hahn, MD (Co-Author) - SUNY Upstate; Hsin Kwung Li, MD, PharmD (Co-Author) - SUNY Upstate