David
Might Trotti have been referring to the percent of patient who have Dysphagia (swallowing disorder) due primarily to radiation/chemoradiation?
Trotti has participate in RTOG chemo-radiation and Dysphagia studies - one in 2008 and it is a significant issue aggravated by chemo-radiation (CRT).
PEG tube dependence can make Dysphagia worse, but in most studies despite Dysphagia, over 80% of patient manage to get off their PEG within a year and over 90% by two years.
Unfortunately some may have to always have a PEG due to other issues but not due to PEG dependence.
A large percentage of us will have dysphagia to varying degrees regardless of whether we had a PEG or not and for many of us this can get worse well after the PEG has been removed.
Anyway, I can't come up with any data supporting a 30% life time dependence rate for PEG users and my RO mailed me back that it is no where near that level. She say Trotti is referring to dysphagia and told me I could email him through the Moffitt.org site.
Study References:
http://www.headneckcancer.net/mt-static/publication_pdfs/Oto-HNS-2006.pdfhttp://www.headandneckcancer.org/meetings/documents/AHNS09FinalProgweb.pdf (section printed below:
P077 (COSM poster #200)
RATES OF PEG TUBE DEPENDENCE AND ESOPHAGEAL
STRICTURE FORMATION FOLLOWING DEFINITIVE CONCURRENT
CHEMOTHERAPY AND INTENSITY MODULATED RADIATION
THERAPY FOR SQUAMOUS CELL CARCINOMA OF THE HEAD AND
NECK - Susan A. McCloskey, MD, Wainwright Jaggernauth, MD, Nestor
R. Rigual, MD, Wesley L. Hicks, MD, Saurin R. Popat, MD, Thom R.
Loree, MD, Mohamed K. Khan, MD, Mary E. Platek, James M. Smaldino,
Anurag K. Singh, MD; Roswell Park Cancer Institute
Background: The incidence and duration of swallowing dysfunction
associated with definitive concurrent chemotherapy and intensity
modulated radiation therapy (IMRT) for management of locally advanced
squamous cell carcinoma of the head and neck (SCCHN) have not
been fully described. Methods: This retrospective review identified 78
consecutive patients treated with definitive concurrent chemotherapy
and intensity modulated radiation therapy (IMRT) for SCCHN at our
institution. Crude rates of percutaneous endoscopic gastrostomy (PEG)
tube dependence and esophageal stricture formation are reported.
Results: Median age of the cohort was 62 (37-81). Median follow-up
was 20 months. Tumor sites included: oropharynx (54%), larynx (36%),
oral cavity (5%), and hypopharynx (5%). 74 of 78 (95%) patients had a
PEG tube placed prior to or during CRT. At the time of this analysis, PEG
tubes had been removed in 63% of patients after a median of 167 days
(range 65 to 666 days). Among 25 patients who had their PEG tubes in
place at last follow-up, median time of PEG dependence was 417 days
(range 109-952 days). At 3, 6, 12, 18, and 24 months respectively, 96%,
61%, 31%, 19%, and 6% of evaluable patients with adequate followup
remained PEG tube dependent. Seventeen of 78 (22%) patients
developed esophageal stricture formation requiring dilatation at a median
of 6 months (range 3-24 months). Conclusions: Esophageal strictures
formed in nearly a quarter of all patients. At one year, nearly one third of
patients remained PEG tube dependent. Given the significant impact of
swallowing dysfunction on quality of life, all efforts should be undertaken
to understand this relationship and minimize this effect. Novel
radioprotector studies are being planned at our institution.