PHILADELPHIA (October 25, 2022)—A small subset of patients who undergo treatment for head and neck cancer may require a gastrostomy tube many years into survivorship, according to a study presented today by researchers from Fox Chase Cancer Center at the annual meeting of the American Society for Radiation Oncology.
“In the context of head and neck cancer a gastrostomy tube is used when a patient cannot swallow effectively, either as a consequence of the tumor itself or of the intensity of the treatment,” said Thomas J. Galloway, MD, chief of the Division of Head and Neck Radiation Oncology at Fox Chase.
A temporary gastrostomy tube may be placed in the middle of treatment and removed a handful of weeks or months later, said Galloway, who is also an associate professor in the Department of Radiation Oncology. However, in some situations a long-term gastrostomy tube may be placed during treatment or later and is not removed.
“From the vantage of a head and neck oncologist, we do not want to take a patient who was otherwise healthy and doing well and give them treatment that is so intense that we cure the cancer but permanently damage their ability to eat for the rest of their lives,” Galloway said.
In order to identify what factors might be associated with an increased likelihood of long-term gastrostomy tube use, Galloway and colleagues pooled data from three large studies that involved 2,389 patients treated with chemotherapy and radiation for head and neck cancer.
Among these patients, the gastrostomy tube rate at treatment initiation was 14%. At one-year posttreatment the rate was 19%, and at nine years posttreatment the rate was 8%.
Patients treated with 3D regimens had significantly higher rates of gastrostomy tubes at baseline, six months, one year, and two years posttreatment compared with patients treated with accelerated regimens. No differences were seen in tube rates for years three to nine.
Predictors of long-term feeding tube use more than five years after completion of treatment were older age, larger primary tumors, and a history of smoking more than 10 packs of cigarettes a year.
“The majority of patients being treated are doing fine three or five years posttreatment, but a small subset of those patients will develop problems deep into survivorship,” Galloway said. “Clinicians need to be mindful of that.”
There are other ongoing studies being conducted at Fox Chase that are looking at less intensive radiation treatment strategies and attempting to identify the minimum effective dose versus the maximum tolerated dose.
“The idea is to be able to give the lowest dose possible to provide cure with the hope that this will also result in fewer feeding tubes seven years later,” Galloway said. “We want to see that a dose reduction translates into a meaningful decrease in long-term feeding tubes in patients.”
The study is titled “Gastrostomy Tube Use in Head and Neck Cancer Survivors: Pretreatment Factors Supersede Treatment Intensification.”