3-weekly or weekly cisplatin concurrently with radiotherapy for patients with squamous cell carcinoma of the head and neck – a multicentre, retrospective analysis

Abstract

BackgroundConcurrent chemoradiotherapy with cisplatin is standard for patients (pts) with loco-regionally advanced squamous cell carcinoma of the head and neck (LA-SCCHN) and for patients with resected SCCHN with high-risk features. The standard regimen includes 3-weekly cisplatin, but weekly regimens are often used to lower toxicity. Reaching a cumulative dose of ≥200 mg/m2 cisplatin was shown being associated with improved outcome. We herein investigated cumulative dose reached and toxicities between the 3-weekly and weekly cisplatin regimens with concurrent radiotherapy.MethodsMulticentre, retrospective analysis of all patients undergoing combined RCT with cisplatin treated at 3 centres in Switzerland between 06/2008 and 12/2015.ResultsThree hundred fourteen pts. were included (3-weekly, N = 127; weekly, N = 187). Median cumulative cisplatin dose was 200 mg/m2 (IQR 150–300) for pts. treated with a 3-weekly schedule and 160 mg/m2 (120–240) for the weekly schedule, consequently more pts. treated with a 3-weekly schedule reached a cumulative dose ≥200 mg/m2 (75.6% vs. 47.1%, p < 0.001). This association was also observed in multivariable analysis adjusted for age and sex (OR 3.46, 95% confidence interval [CI], 2.1–5.7). The 3-weekly regimen led to a higher rate of acute renal toxicity (33.1% vs. 20.9%, p = 0.022). In the landmark analysis, we could not confirm that a cisplatin dose ≥200 mg/m2 is associated with better survival (HR 1.3, 95% CI 0.8–1.9).ConclusionsSignificantly more patients receive a cumulative cisplatin dose of ≥200 mg/m2, when treated with a 3-weekly schedule compared to weekly dosing. The previously reported association between a cumulative cisplatin dose ≥200 mg/m2 and improved outcome could not be shown in our study.

Definitive chemoradiotherapy in patients with squamous cell cancers of the head and neck - results from an unselected cohort of the clinical cooperation group “Personalized Radiotherapy in Head and Neck Cancer”

“…With the limitation of the small number of patients in this study and without any difference between MMC-based and platin-based chemotherapy for all endpoints, MMC/5-FU could at least be considered as an alternative therapeutic option. However, in the published literature cisplatin is reported as the standard treatment for a simultaneous monotherapy with the strongest effect [17, 18]. The clinical results of our ARO-analog subgroup and the ARO 95–06 trial were comparable with a 5-year PFS of 30.4% versus 29.3% and a 5-year OS of 36.4% versus 28.6%.…”

Patient reported outcomes in patients with head and neck cancer treated with concurrent chemoradiation with weekly versus bolus cisplatin

“…Similar to our study, the rate of PEG dependence was not different (63.7% in B-CP and 56.1% in the W-CP). 15 Another randomized study reported by Tsan et al including 50 patients (26 in B-CP and 24 in W-CP group) showed a higher rate of mucositis (75% vs 38.5%, P = .01) and grade 4 toxicity (25% vs 0%, P = .02) in patients treated with B-CP. 16 On the other hand, there are studies that did not show a significant toxicity difference in patients with B-CP and W-CP.…”

Concurrent chemoradiation in head and neck cancers with weekly cisplatin: analysing toxicities

“…In a latest study, only 47% of the patients were able to receive dose >200 mg/m 2 with weekly cisplatin while 76% of patients received this dose with three weekly cisplatin. 13 This could be due to flexibility of decision of chemotherapy which is to be done at only two time points. Also, it can be hypothesized that most of the patients will have recovered from high dose toxicities of chemotherapy.…”