Prospective evaluation of factors associated with acceptance of feeding tube (FT) placement and clinical outcomes during radiation therapy (RT) or radiochemotherapy (RTCT) for head and neck squamous cell carcinoma (HNSCC).
Authors: Clatot Florian , Mihailescu Sorina , Ebran Mélanie , Rigal Olivier , Guérault Fanny , Moldovan Cristian , Veresezan Ovidiu , Thureau Sébastien 
Published: June 2023

12103

Background: RT/RTCT during HNSCC treatment is associated with a high rate of severe dysphagia requiring the use of a FT. Randomized trials have failed to show a benefit of a prophylactic enteral nutrition in case of RTCT. Even when indicated, numerous patients refuse the placement of a FT. We assessed the factors associated with FT acceptance and outcomes between patients that had a FT, or not. Methods: The monocentric NutriNeck study (NCT02900963) recruited all HNSCC patients between 2014 and 2018 treated by RT/RTCT for curative intent. Patients fed by enteral nutrition before RT initiation were excluded. A daily monitoring of the weight and a weekly clinical evaluation during RT/RTCT were performed, as well as a quality-of-life (QoL) assessment using QLQ-C30 and HN 35 at baseline, 3 and 9 months after the end of treatment. A nutritional intervention by FT was systematically proposed in case of 2 kg weight loss under treatment or severe dysphagia. Patients were considered into 3 groups: FT indication and acceptation, FT indication but refusal, no FT indication. A p value < 0.05 was considered significant. Results: Among the 250 HNSCC patients included, 119 (48%) were treated by RT and 131 (52%) by RTCT. Overall, 114 patients (46%) accepted FT, 48 (19%) refused an indicated FT and 88 (35%) had no FT indication. In multivariable analysis, the only factor associated with an indication of a FT tube was having a RTCT vs a RT (p < 0.0001). Among the 162 patients (65%) with FT indication, in multivariate analysis factors associated with FT placement acceptance were having a RTCT (p = 0.01), being treated by exclusive RT+/-CT instead of adjuvant RT/CT (p = 0.05), having a tumor of the oral cavity (p = 0.02), having at baseline a decreased role functioning score (p = 0.04). When using linear mixed models for QoL analyses, over time role functioning, social functioning and pain were the only categories significantly different between patients that accepted FT and patients that refused or had no FT indication. At the end of treatment, median weight loss was significantly more important among patients with FT indication, compared to patients without FT indication (-4% vs -1%, respectively, p < 0.0001). This difference remained significant 3 and 9 months after the end of treatment. Among patients with FT indication, there was no difference in case of FT placement acceptance or refusal regarding grade 3 toxicities during treatment or weight loss at the end of treatment, after 3 and 9 months of follow-up. Conclusions: One third of the patients with an indicated FT have refused the FT placement, and did as well as those that accepted. Using baseline QoL items such as decreased role or social functioning, or increased pain may help identifying a subgroup of patients for which an earlier FT placement should be considered.