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Impact of dosimetric factors on long-term percutaneous enteral gastrostomy (PEG) tube dependence in head and neck cancer patients after (chemo)radiotherapy—results from a prospective randomized trial
Strahlentherapie und Onkologie ( IF 2.7 ) Pub Date : 2022-08-25 , DOI: 10.1007/s00066-022-01992-5
Anastassia Löser 1, 2 , Maximilian Grohmann 3 , Anna Finger 1 , Franziska Greinert 1 , Linda Krause 4 , Isabel Molwitz 5 , Andreas Krüll 1, 3 , Cordula Petersen 1, 3
Affiliation  

Purpose/objective

To analyze dose–volume histogram (DVH)-derived data on the exposure of organs at risk with impact on long-term percutaneous enteral gastrostomy (PEG) tube dependence in head and neck cancer patients at 6 and 12 months after definitive or adjuvant (chemo)radiotherapy.

Materials and methods

Sixty-one patients were prospectively treated with (chemo)radiotherapy. Prophylactic or reactive gastrostomy tube placement was performed in 41 (67.2%) patients. Dose–volume histogram parameters were obtained for the swallowing apparatus.

Results

Median follow-up time was 25 (2–34) months. Overall survival was shorter in patients with inlying PEG tubes at 6 and 12 months (log rank p = 0.038 and p = 0.017) after therapy completion. The estimated median time of tube dependency was 6 (95% confidence interval: 2–14) months. After 6 months, 46.5% of patients were tube dependent. After 12 months, this estimated proportion fell to 31.5%. For both time points, the volume to the larynx (in %) receiving at least 50 Gy (larynx V50Gy) exceeding 53% was predictive for long-term tube feeding (6 months: p = 0.041 and 12 months: p = 0.042) being an independent predictor during multivariable analysis. There was no clinical feature influencing tube dependence after 12 months.

Conclusion

Long-term gastrostomy dependence was found to be strongly associated with an exposure of laryngeal structures (specifically, V50Gy ≥ 53%) during radiotherapy. Consequently, the avoidance of supraglottic as well as glottic structures is warranted.



中文翻译:

剂量学因素对(化疗)放疗后头颈癌患者长期经皮肠内胃造口术 (PEG) 管依赖性的影响——前瞻性随机试验的结果

目的/目标

分析剂量体积直方图 (DVH) 衍生的关于暴露风险器官的数据对头颈癌患者在根治性或辅助性化疗后 6 个月和 12 个月长期经皮肠胃造口术 (PEG) 管依赖性的影响)放射治疗。

材料和方法

61 名患者接受了(化疗)放疗的前瞻性治疗。41 名 (67.2%) 患者进行了预防性或反应性胃造瘘管放置。获得吞咽装置的剂量-体积直方图参数。

结果

中位随访时间为 25 (2–34) 个月。在治疗完成后的 6 个月和 12 个月(log rank p  = 0.038 和p  = 0.017),植入 PEG 管的患者的总生存期较短。管依赖的估计中位时间为 6(95% 置信区间:2-14)个月。6 个月后,46.5% 的患者依赖管子。12 个月后,这个估计比例下降到 31.5%。对于这两个时间点,接受至少 50 Gy(喉 V50Gy)的喉体积(以 % 表示)超过 53% 可预测长期管饲(6 个月:p  = 0.041 和 12 个月:p  = 0.042)多变量分析期间的独立预测因子。12 个月后没有影响管依赖性的临床特征。

结论

发现长期胃造口术依赖与放疗期间喉部结构暴露(特别是 V50Gy ≥ 53%)密切相关。因此,有必要避免声门上和声门结构。

更新日期:2022-08-25
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