ORIGINAL ARTICLE Gastrostomy tube placement in patients with oropharyngeal carcinoma treated with radiotherapy or chemoradiotherapy: Factors affecting placement and dependence Mihir K. Bhayani, MD, Katherine A. Hutcheson, PhD, Denise A. Barringer, MS, Asher Lisec, BS, Clare P. Alvarez, MS, Dianna B. Roberts, PhD, Stephen Y. Lai, MD, PhD*, Jan S. Lewin, PhD* Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston Texas. Accepted 17 September 2012 Published online 16 January 2013 in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/hed.23200 ABSTRACT: Background. Although many patients require nutritional support during radiotherapy or chemoradiotherapy for oropharyngeal cancer, little is known regarding the risk factors that predispose to gastrostomy tube (g-tube) placement and prolonged dependence, or the therapeutic interventions that may abrogate these effects. Methods. We performed a retrospective medical chart review of patients who were treated for primary oropharyngeal cancer at a tertiary care center from 2003 to 2008. Patients who had a complete response at the primary site at 1-year posttreatment were included. G-tube placement and dependence 6 months were evaluated in relationship to site and stage of primary tumor, baseline characteristics, treatment type, smoking status, and swallowing intervention. Results. We evaluated 474 patients (79%) with oropharyngeal cancer; 215 patients (40%) had concurrent chemotherapy, 73 patients (15%) had induction chemotherapy, and 69 patients (15%) had induction chemotherapy followed by concurrent chemotherapy. Two hundred ninety-three patients (62%) received g-tubes, of which 238 (81%) received the g-tube during radiation. At 1-year follow-up, 41 patients (9%) remained dependent on enteral feedings. Placement of g-tubes and prolonged g-tube dependence were significantly more likely in patients with T3 to 4 tumors (p < .001), baseline self-reported dysphagia (p < .001), odynophagia (p < .001), >10% baseline weight loss (p < .001), and in those treated with concurrent chemoradiotherapy. Patients who reported adherence to exercises had significantly lower rates of g-tube placement (p < .001), and duration of dependence was significantly shorter in those who reported adherence to swallowing exercises (p < .001). Conclusion. Almost 40% of patients with oropharyngeal cancer treated with nonsurgical organ preservation modalities may avoid feeding tube placement. Factors that predispose to g-tube placement and prolonged dependence include T3 to T4 tumors, concurrent chemotherapy, current smoking status, and baseline swallowing dysfunction or weight loss. Adherence to an aggressive swallowing regimen may reduce long-term dependence on enteral nutrition and limit the rate of g-tube placement overall. V C 2013 Wiley Periodicals, Inc. Head Neck 35: 1634–1640, 2013 KEY WORDS: oropharynx, gastrostomy tube, dysphagia, speech pathology, radiation therapy INTRODUCTION Despite the decreased prevalence of smoking in the United States, the incidence of oropharyngeal carcinoma is rising. 1–3 This increase has been attributed to the iden- tification of oncogenic human papillomavirus (HPV) in approximately 70% of all tumors in patients with oropha- ryngeal carcinoma. 2 Studies have shown that definitive treatment regimens of radiation therapy (RT) alone and in combination with chemotherapy can improve locoregional control, provide functional organ preservation, and main- tain survival in patients with locally advanced head and neck cancer; however, the side effects can be consider- able. 4–7 Treatment-related side effects such as mucositis and dysphagia may lead to inadequate oral intake, and consequently severe weight loss and malnutrition in this high-risk population. 8–10 Malnutrition is a recognized complication of head and neck cancer and its treatment. 4 The clinical significance of which is manifested by dehydration-related emergency room visits and hospitalizations, reduced treatment effi- cacy because of treatment delays, and dose reductions that negatively impact quality of life and overall sur- vival. 5,6 In an effort to avoid malnutrition, patients under- going RT are commonly referred for placement of a gas- trostomy tube (g-tube). The g-tube helps maintain adequate nutrition, prevent weight loss, and eliminate aspiration, particularly in patients with mucositis-induced odynophagia and dysphagia during RT. Despite the benefits of g-tube placement in appropri- ately selected patients, the timing of g-tube placement remains controversial. Multiple reports encourage prophy- lactic g-tube placement to prevent weight loss and dehy- dration; thus, enabling patients to complete treatment without interruption. 7–11 However, other studies have *Corresponding authors: J. Lewin, Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1445, Houston TX 77030. E-mail: jlewin@mdanderson.org; or S. Y. Lai, Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1445, Houston TX 77030. E-mail: sylai@mdanderson.org Ehab Y. Hanna, MD, was recused from consideration of this manuscript. This work was presented at the ASTRO Annual Meeting, Miami, Florida, October 2011. Stephen Y. Lai and Jan S. Lewin contributed equally to this work. 1634 HEAD & NECK—DOI 10.1002/HED NOVEMBER 2013