2881 - Percutaneous Endoscopic Gastrostomy Tube Placement in Patients with Oropharyngeal Cancer in Single Institution over Five Years
Presenter(s)
Y. Wu1, T. Treechairusame2, F. Yang3, E. C. Dee4, N. Riaz4, A. Shamseddine4, Y. Yu4, S. McBride4, K. Zakeri4, D. Gelblum4, L. Chen5, J. J. Kang6, C. J. Tsai7, and N. Y. Lee4; 1Memorial Sloan-Kettering Cancer Center, New York, NY, 2Division of Radiation Oncology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, 3Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, 4Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 5Memorial Sloan Kettering Cancer Center, New York, NY, 6Yale University, New Haven, CT, 7Princess Margaret Cancer Centre, Toronto, ON, Canada
Purpose/Objective(s): One standard treatment paradigm for oropharyngeal squamous cell carcinoma (OPSCC) is 7 weeks of radiation therapy (RT) +/- chemotherapy. Treatment is associated with substantial morbidities such as dysphagia, pain, dehydration, dysgeusia, and weight loss. As a result, some patients require percutaneous endoscopic gastrostomy (PEG) for nutritional support to complete therapy. We aim to assess the PEG tube utilization in our institution and identify associated risk factors.
Materials/Methods: From 2019 through 2023, consecutive patients with OPSCC who underwent RT with curative intent were included. Patients who had PEG tube placement were recorded, including indication for PEG tube and date of PEG placement and removal. Patients’ demographic data and clinical characteristics, including T stage, N stage, HPV status, disease subsite, postop or definitive, proton or photon, induction chemotherapy and concurrent chemotherapy were collected. Logistic regression analysis was used to identify independent risk factors associated with PEG tube placement.
Results: There were 649 patients (508 received photon RT, 139 received proton RT, and 2 received combination of photon and proton RT), 73 (11.2%) required temporary reactive placement of PEG tube; no prophylactic PEG tube was placed. Median time from the start of radiation to PEG placement was 5.57 weeks (IQR 4.1-11.7 weeks). Median duration of PEG in place was 19 weeks (IQR 13.3-32.1 weeks). Of 73 patients who had PEG tube placed, 11 (15.1%) received PEG tube prior to radiation, 51 (69.8%) had PEG placement within 3 months after radiation completion, and 11 (15.1%) had PEG placed greater than 3 months from radiation completion. The major reason for PEG placement prior to and within 3 months after RT completion was dysphagia. Among 11 PEG tubes that were placed 3 months after radiation completion, 5 were due to recurrent disease; and the other 6 were related to long term side effects from radiation (i.e. soft tissue necrosis, osteonecrosis, and dysphagia). Independent risk factors for PEG tube placement included tumor T stage of 3 or higher [odds ratio (OR), 3.66; 95% CI, 2.20- 6.07; P<0.05], smoking history [odds ratio (OR), 2.03; 95% CI, 1.09- 3.80; P<0.05], induction chemotherapy [odds ratio (OR), 4.36; 95% CI, 1.88- 10.10; P<0.05] and concurrent chemotherapy [odds ratio (OR), 5.76; 95% CI, 1.24- 26.64; P<0.05]. Among 508 patients who were treated with photon RT, 63 (12.4%) received PEG tube; while 10 (7.2%) of 139 patients treated with proton RT had PEG tube placed. Patients who received proton therapy trended towards having lower risk for PEG placement [odds ratio (OR), 0.54; 95% CI, 0.27- 1.07; P=0.08].
Conclusion: Although most of the reactive PEG tubes were placed within 3 months after radiation completion, the risk for long-term PEG tube placement was low. Tumor T stage of 3 or higher, smoking history, induction chemotherapy, and concurrent chemotherapy are associated with reactive placement of PEG tube.