Prediction model for tube feeding dependency during chemoradiotherapy for at least four weeks in head and neck cancer patients: A tool for prophylactic gastrostomy decision making

Background & aims: Chemoradiation and bioradiation (CRT/BRT) for locally advanced head and neck
squamous cell carcinoma (LAHNSCC) often comes with high toxicity rates, interfering with oral intake
and leading to temporary tube feeding (TF) dependency. High-quality scientific evidence for indicators of
prophylactic gastrostomy insertion is not available. The aim of this retrospective cohort study was to
develop a prediction model to identify patients who need prophylactic gastrostomy insertion, defined as
the expected use of TF for at least four weeks.
Methods: Four-hundred-fifty LAHNSCC patients receiving CRT/BRT with curative intent between 2013
and 2016 were included in the study. Primary outcome was TF-dependency for four weeks or longer.
Patient, tumor, and treatment characteristics were extracted from the medical records and their effects
on the use of TF were analyzed using univariable and multivariable analysis. The prediction model was
internally validated using bootstrapping techniques.
Results: Sixty-five percent (294/450 patients) required TF for four weeks or longer. Variables included in
the model were: body mass index and adjusted diet at start of CRT/BRT, percentage weight change at
baseline, World Health Organization performance status, tumor subsite, TNM-classification, CRT/BRT,
mean radiation dose on the contralateral submandibular and parotid gland. The corrected Area Under the
Curve after internal validation was 72.3%, indicating good discriminative properties of the prediction
model.
Conclusions: We developed and internally validated a prediction model that is intended to estimate TFdependency
for at least four weeks in LAHNSCC patients treated with CRT/BRT. This model can be used as
a tool to support personalized decision making on prophylactic gastrostomy insertion.