Risk Factors of Prolonged Duration of Gastrosoma Placement in Locally Advanced Head and Neck Cancer Patients with Ccrt

Abstract

Background: CCRT is a standard treatment for locally advanced head and neck cancer patients, but mucositis and other gastrointestinal adverse events occur frequently, which often make patients unable to take anything by mouth and need to be fed by gastrostoma feeding. Some patients need gastrostoma for long after the end of CCRT. We investigated risk factors for prolonged duration of gastrostomy. Methods:We retrospectively analyzed non-metastatic head and neck cancer patients treated with CCRT from November 2005 to April 2012 in our hospital. Chemotherapy consisted of cisplatin (CDDP) (80 mg/m2 per 3 weeks), but carboplatin (AUC 1.5 weekly) or docetaxel (10 mg/m2 weekly) was administered in case patients were consider to be intolerable to CDDP according to physicians' estimation. Radiation therapy was performed as three-dimensional radiotherapy (3D-RT) or intensity-modified radiotherapy (IMRT), consisting of 66-70 Gy in 33-35 fractions over 7 weeks. Results: A total of 182 patients (155 male, 27 female; median age 58.4 years) received CCRT, of which 145 (80.0%) received percutaneous endoscopic gastrostomy. Median follow-up time was 21.9 months (range 0.99-71.0 months). One hundred fourteen patients could have removed gastrostoma, of which 95 patients (83%) could have removed within 200 days after last radiation day. In logistic regression analysis, regular use of opioids (p = 0.0079) was associated with prolonged duration of gastrostoma placement. Conclusion: Severe mucositis with pain lead regular use of opioids. In CCRT to head and neck cancer patients, control of mucositis could shorten the duration of gastorstoma placement.