Creating Guidelines for Reactive and Prophylactic Enteral Feeding in Definitive (Chemo) IMRT for Head-and-Neck Cancer

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Purpose/Objective(s)

Enteral feeding tubes (FT) are commonly utilized in patients undergoing intensity modulated radiation therapy (IMRT) for head and neck cancer to assist nutritional maintenance. Enteral feeding (EF) protocols vary between institutions: prophylactic centers (PC) insert FTs prior to acute toxicity onset in most patients and reactive centers (RC) generally insert FTs upon failure of adequate oral nutrition. Numerous nutritional guidelines recommend a prophylactic FT if EF is likely to persist for

Methods/Materials

This study identified 115 patients treated with definitive IMRT in a PC between 2007 and 2012. Gross disease was treated to 70 Gy/35 fractions and bilateral, elective necks to 56 Gy. EF duration and intensity was gleaned from a prospective nutritional database to identify patients as: (a) low feeding (LF), using a FT for 25-75% of dietary needs for <4 weeks OR; (b) high feeding (HF), using a FT for ≥ 75% of needs for >6 weeks. Differences in frequency distributions of demographics, use of

Results

The Table displays univariate predictors of LF and HF. Both LF and HF were associated with advanced disease and chemotherapy use. While nodal stage was a significant discriminator of LF, only the primary tumor extent was significant for HF. The same pattern was observed in relation to PTV 70 Gy length. This may be a product of the conformality of the high risk volume and the steeper dose gradient achieved around nodal volumes, sparing the pharyngeal axis with IMRT. Oropharyngeal primaries were

Conclusions

Irrespective of institutional philosophy, these findings legitimize reactive FTs in patients with low volume primary and nodal disease, treated without chemotherapy, and prophylactic FTs in patients with advanced primary tumors, treated with chemotherapy, regardless of neck disease. The apparent pharyngeal sparing of IMRT despite advanced nodal disease warrants further dosimetric investigation.

. Univariate predictors of low and high feeding

Low feeding (LF): ≥25% of dietary needs via feeding tubeEmpty Cell

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Author Disclosure: N.J. Anderson: None. J. Jackson: None. M. Wada: None. M. Schneider-Kolsky: None. M. Rolfo: None. H. Gan: None. K. Kaegi: None. F. Sneyd: None. D. Lim Joon: None. V. Khoo: None.

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