Predictors of Gastrostomy Placement and Dependence in Oropharyngeal Cancer Patients Treated with Chemoradiotherapy

AbstractIntroductionTreatment of oropharyngeal cancer (OPC) with primary chemoradiotherapy (CRT) may necessitate placement of a gastrostomy tube (GT). We sought to identify factors that may predict GT placement and dependence.Materials and methodsA retrospective review of 61 consecutive patients receiving primary CRT for OPC over a 10-year period at a tertiary referral center. Patients with prior head and neck malignancy, distant metastasis, incomplete treatment course, or inadequate follow-up were excluded. Forty-four patients were included for analysis.ResultsSixty-one percent of tumors were located in the tonsil and 62% were stage IV disease at presentation. Complete response to CRT occurred in 36 patients, among whom GT placement was more likely when weight loss occurred before the start of CRT than after CRT (p= 0.028). Continued GT dependence was more likely in patients with GT placement after the start of CRT (p= 0.019). Multivariate analysis showed significant associations of GT placement with post-treatment dysphagia and mucositis. Advanced tumor stage was a significant predictor of GT dependence.ConclusionsProphylactic GT placement may be advisable in patients receiving CRT for OPC who have pretreatment weight loss. Conversely, GT may be withheld from asymptomatic patients.