Predictors of PEG dependence after IMRT ± chemotherapy for oropharyngeal cancer

Giuseppe Sanguineti, Nikhil Rao, Brandon Gunn, Francesco Ricchetti, Claudio Fiorino

Research output: Contribution to journalArticlepeer-review


Purpose To prospectively assess predictors of PEG dependence after IMRT with/without concomitant chemotherapy (CHT). Methods and materials One-hundred-seventy-one patients were considered (exclusive RT: 58, RT+CHT: 113; 159/171 treated at a median dose of 70 Gy, 2 Gy/fr). Patients treated with RT+CHT underwent prophylactic PEG insertion; PEG was as needed for the others. A number of clinical factors and dose-volume information concerning oral mucosa (OM), constrictors, masticatory muscles, larynx, esophagus and parotids were available. The 25th/10th percentiles of the duration of PEG dependence were our end-points (respectively 3.3 and 7 months, PEG3/PEG7). Logistic uni and multi-variate (MVA) analyses were performed. Results Concerning PEG3, the independent predictors at MVA were: CHT/PEG policy (OR: 6.8, p = 0.001), V9.5G-OM Gy/week (OR: 1.017, p = 0.01), larynx V50 (OR: 1.018, p = 0.01) and superior constrictor (SC) D-mean (OR: 1.002, p = 0.005); the predictive value of the model (AUC) was 0.818 (95% CI: 0.751-0.873). The independent predictors of PEG7 were: larynx V50 (OR: 1.042, p = 0.0005) and SC D-mean (OR: 1.003, p = 0.02), symptoms at diagnosis (yes vs no, OR: 3.6, p = 0.08) and sex (male vs female, OR: 0.25, p = 0.07); AUC was 0.897 (95% CI: 0.841-0.939). Conclusions OM V9.5 Gy/week and CHT/PEG-policy modulate the risk of early PEG dependence. For longer PEG dependence, larynx V50 (or D-mean) and SC D-mean are highly predictive, suggesting that the fibrosis of constrictors and larynx is the main cause.

Original languageEnglish
Pages (from-to)300-304
Number of pages5
JournalRadiotherapy and Oncology
Issue number3
Publication statusPublished - Jun 2013


  • Dysphagia
  • IMRT
  • PEG tube
  • Predictive models

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Hematology


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