Clinical and dosimetric risk stratification for patients at high-risk of feeding tube use during definitive IMRT for head and neck cancer

James E Jackson; Nigel J Anderson; Morikatsu Wada; Michal Schneider; Michael Poulsen; Maureen Rolfo; Maziar Fahandej; Hui Gan; Daryl Lim Joon; Vincent Khoo

doi:10.1016/j.tipsro.2020.01.003

Clinical and dosimetric risk stratification for patients at high-risk of feeding tube use during definitive IMRT for head and neck cancer

Tech Innov Patient Support Radiat Oncol. 2020 Feb 28:14:1-10. doi: 10.1016/j.tipsro.2020.01.003. eCollection 2020 Jun.

Authors

James E Jackson^{1

2

3

4

5}, Nigel J Anderson^{1

6

4}, Morikatsu Wada¹, Michal Schneider⁴, Michael Poulsen^{5

7}, Maureen Rolfo¹, Maziar Fahandej^{1

8}, Hui Gan⁹, Daryl Lim Joon^{1

5}, Vincent Khoo^{1

4

10

11}

Affiliations

¹ Department of Radiation Oncology, Olivia Newton John Cancer Wellness & Research Centre, Austin Health, Heidelberg, Victoria, Australia.
² School of Medicine, Griffith University, Gold Coast, Australia.
³ Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
⁴ Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Sciences, Monash University, Victoria, Australia.
⁵ Icon Cancer Centres, Gold Coast University Hospital, Queensland, Australia.
⁶ Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
⁷ Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia.
⁸ Department of Palliative Care, St Vincent's Hospital, Fitzroy, Victoria, Australia.
⁹ Olivia Newton-John Cancer Research Institute, Austin Health, Heidelberg, Victoria, Australia.
¹⁰ Department of Clinical Oncology, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Chelsea, London, UK.
¹¹ Department of Medicine, University of Melbourne, Victoria, Australia.

Abstract

Introduction: To identify organs to which dose limitation using intensity modulated radiotherapy (IMRT) can potentially modify the incidence and duration of feeding tube use, during and immediately following therapy for head and neck cancer.

Materials and methods: One hundred and fourteen patients treated with definitive IMRT (± concurrent chemotherapy) head and neck mucosal cancers were included. Patients received a prophylactic feeding tube and followed up by a dietician for at least eight weeks post-radiotherapy. Salivary and swallowing organs were delineated for each patient. Tumour and dosimetric variables were recorded for all patients and analysed for incidence and duration of feeding tube use for at least 25% of dietary requirements.

Results: Multivariate analysis showed T-classification ≥3 and level II lymphadenopathy as independent significant predictors of incidence and duration of feeding tube use in oral cavity, pharyngeal and supraglottic primaries. Mean dose deposited in the cervical oesophagus over 36Gy further increased the incidence and duration of feeding tube use. Mean dose deposited in the base of tongue and superior pharyngeal constrictor muscles affected incidence and duration of feeding tube use, respectively.

Discussion: In patients treated with definitive IMRT, T-classification and Level II lymphadenopathy, combined with a mean cervical oesophagus dose over 36Gy can a stratify patients into eight distinct risk groups for using feeding tubes for at least 25% of their dietary requirements.

Keywords: Enteral nutrition; Head and neck neoplasms; Intensity-modulated; Radiation dosage; Radiotherapy.