3D Radiotherapy Planning Decreases Use of Feeding Tubes

A recent analysis sought to identify which treatment-related factors are more apt to avoid feeding-tube dependency.

"Three-dimensional [3D] treatment planning appears to have a significant impact on improving quality of life by reducing feeding tube dependency,” said medical intern Linna Li, M.D., from Fox Chase Cancer Center (Philadelphia, PA, USA).

The retrospective study assessed treatment records since 1997 for patients receiving definitive radiation therapy, with or without surgery and chemotherapy, for squamous-cell carcinomas of the throat, including the oropharynx, hypoharynx, and larynx.

The 90 study participants had either stage III or IV cancer with no prior surgery or radiation therapy in the head and neck region, and remained cancer-free 18 months or more after completing radiation therapy. The majority of patients were men (82%) who had oropharyngeal cancer (63%) with a T stage (extent of primary tumor, including size, at diagnosis) of either T2 or T3 (71%%).

Only 44% had neck surgery, but 58 % had concurrent chemotherapy. Only 10% had radiation treatments using modified fractionation schemes. Sixty percent had two-dimensional (2D) treatment planning for radiation therapy, while 40% had three-dimensional computed tomography- (CT)-based treatment planning.

A feeding tube was placed in 56 of these 90 patients (62%): 19 before radiation therapy, 26 during radiation therapy, and 11 after radiation therapy. Two-thirds of the men had the feeding tube removed during the follow-up period, with only 15% retaining the tube after 18 months.

"In analyzing the factors associated with feeding tube dependency at 18 months, only the higher T stage and 2D treatment planning were independent predictors,” Dr. Li stated. "Of the 54 patients who had 2D treatment planning, 20 were feeding-tube dependent at 18 months compared to just five of the 36 who had 3D treatment planning. Of the three patients who had intensity-modulated radiation therapy instead of traditional radiation, none were feeding tube-dependent.



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Fox Chase Cancer Center