Comparison of acute toxicities of two chemotherapy schedules for head and neck cancers

Geeta, S; Tk, Padmanabhan; Samuel, Jacob; Pavithran, Keechilat; Iyer, Subramania; Kuriakose, Moni Abraham

doi:10.4103/0973-1482.27584

Cited by 49 publications

(17 citation statements)

References 23 publications

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“…Six studies supplied data of grade≥3 neutropenia [6, 8, 10–13] among which included 178 patients in the weekly group and 194 patients in the three weekly group. Forest plot showed that patients in the two arms had similar risk of neutropenia and thrombocytopenia with RR of o.85 and 1.13, respectively (95%CI 0.49-1.48, p=0.57; 95%CI 0.42-3.01, p=0.81) (Supplementary Figure S1 and S2).…”

Section: Resultsmentioning

confidence: 99%

“…Six eligible studies [6, 8–11, 15] had the data for grade≥3 dermatitis, which included 213 patients in weekly group and 269 patients in three weekly group. The weekly arm appeared similar risk of dermatitis compared to three weekly arm, with an RR of 1.23 (95%CI 0.84-1.82, p=0.29) (Supplementary Figure S5).…”

Section: Resultsmentioning

confidence: 99%

“…The weekly arm appeared similar risk of dermatitis compared to three weekly arm, with an RR of 1.23 (95%CI 0.84-1.82, p=0.29) (Supplementary Figure S5). Five of these studies were non-NPC [6, 8–11] with 140 weekly patients and 188 three weekly patients, and there was no significant difference in the grade≥3 dermatitis between the two groups of non-NPC patients (RR=1.31, 95%CI 0.88-1.95, p=0.18). No heterogeneity was observed for dermatitis analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Eight articles [6, 8–10, 12–15] of 624 patients reported the data of mucosal toxicity. No obvious difference was observed for the risk of grade≥3 mucositis between the two groups.…”

Section: Resultsmentioning

confidence: 99%

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A meta-analysis of weekly cisplatin versus three weekly cisplatin chemotherapy plus concurrent radiotherapy (CRT) for advanced head and neck cancer (HNC)

Guan

Zhang

et al. 2016

Oncotarget

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PurposeThis study was performed to compare the efficacies and acute toxicities in weekly- and three weekly- cisplatin based concurrent chemoradiotherapy (CCRT) for advanced HNC patients.Results779 patients of 10 studies were eligible. No difference in the 2-, 3-year OS or 1-, 2-year LRFS was observed, whereas patients in three weekly CCRT arm tended to have a better 5-year OS (HR=1.79, 95%C 0.97-3.31, p=0.06). Weekly arm seemed to show less gastrointestinal toxicities (RR=0.59, 95%CI 0.34-1.02, p=0.06), but similar hematologic toxicity compared to three weekly arm. Subgroup analysis displayed more grade ≥3 mucositis (RR=1.72, p=0.01), and more chemotherapy related delay/interrupt (RR=2.68, p<0.0001) in weekly arm for non-nasopharynx carcinoma (non-NPC) HNC.MethodsWe conducted the meta-analysis by searching PubMed, MEDLINE, ScienceDirect, Cochrane Library and China National Knowledge Infrastructure (CNKI) databases. The primary endpoint was overall survival (OS) with secondary endpoints locoregional recurrence-free survival (LRFS) and grade≥3 acute adverse events. RevMan 5.2 was used to perform statistical analyses.ConclusionsThree weekly cisplatin-based CCRT might achieve a higher long-term OS with no significant difference in a shorter OS and LRFS. Weekly arm was associated with less gastrointestinal toxicities but more grade≥3 mucositis and chemotherapy related delay/interrupt. Large randomized trials were urgent to further define superiority of these two regimens.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…Eight articles [6, 8–10, 12–15] of 624 patients reported the data of mucosal toxicity. No obvious difference was observed for the risk of grade≥3 mucositis between the two groups.…”

Section: Resultsmentioning

confidence: 99%

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A meta-analysis of weekly cisplatin versus three weekly cisplatin chemotherapy plus concurrent radiotherapy (CRT) for advanced head and neck cancer (HNC)

Guan

Zhang

et al. 2016

Oncotarget

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“…Patients are randomised to receive accelerated radiotherapy alone to 60 Gy given six fractions a week over 5 weeks versus 60 Gy using standard fractionation over 6 weeks with dose-reduced weekly cisplatin (40 mg/m 2 weekly, total 240 mg/m [2]). Retrospective data suggest that the weekly chemotherapy schedule results in significantly reduced severity of mucositis compared to the traditional schedule of delivery every 3 weeks [54]. Notably, both arms represent a 10 Gy reduction in total radiotherapy dose.…”

Section: De-intensification Trials For Hpv-associated Opsccmentioning

confidence: 99%

Treatment de-intensification strategies for head and neck cancer

Kelly

Husain

Burtness

2016

European Journal of Cancer

100

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Increasingly, squamous cell carcinoma of the oropharynx (OPSCC) is attributable to transformation resulting from high-risk human papillomavirus (HPV) infection. Such cancers are significantly more responsive to treatment than traditional tobacco- and alcohol-associated squamous cell cancers of the head and neck. Conventional management with definitive chemoradiation, surgery and adjuvant radiation, or radiation given with altered fractionation schemes, while effective, incurs long-term morbidity that escalates with treatment intensity and significantly impairs quality of life. Recent trials have suggested that less intensive treatment regimens may achieve similar efficacy with decreased toxicity. In this article, we review the primary strategies used for de-escalation of treatment, which include the reduction of radiation dose, substitution and/or elimination of concurrent radiosensitising chemotherapy, and the use of minimally invasive surgery. We discuss the rationale behind these approaches and the preliminary data demonstrating the success of de-escalation, as well as potential considerations raised by treatment de-intensification in HPV-associated OPSCC.

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Comparing high‐dose cisplatin with cisplatin‐based combination chemotherapy in definitive concurrent chemoradiation setting for locally advanced head and neck squamous cell carcinoma (LAHNSCC)

et al. 2019

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Background High‐dose cisplatin (Cis) is a preferred systemic agent for concurrent chemoradiation (CRT) in locally advanced head and neck squamous cell cancer (LAHNSCC) patients. As some patients are unable to tolerate Cis, this study compares the toxicity and efficacy of weekly cisplatin‐paclitaxel (CP) regimen with Cis. Methods Patients with LAHNSCC receiving definitive chemoradiation either with Cis (Cisplatin—100 mg/m2 q3w x 3) or CP (Cisplatin—20 mg/m2; Paclitaxel—30 mg/m2qw x7) were included. Results Cis and CP groups were comprised of 114 and 111 subjects, respectively. Complete response for Cis versus CP groups was 88% versus 88%, respectively. Median follow‐up for the study was 58.5 months. After adjusting for potential treatment selection bias, no significant differences were evident between Cis and CP groups for overall survival (hazard ratios [HR] 0.85, 95% CI 0.59‐1.21, P = 0.36), progression free survival (HR 0.88, 95% CI 0.62‐1.24, P = 0.46), locoregional control (HR 0.77, 95% CI 0.52‐1.15, P = 0.21), and distant control (HR 0.87, 95% CI 0.61‐1.23, P = 0.42). Patients in the CP group had less acute and chronic toxicities. Conclusions Weekly CP regimen can serve as an alternative systemic therapy with radiation in patients with LAHNSCC who are not fit for Cis.

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Comparison of acute toxicities of two chemotherapy schedules for head and neck cancers

Abstract: Three weekly CT is less toxic than weekly. Weekly CT can be made more acceptable by reducing the dose and using feeding tubes for nutrition.

Cited by 49 publications

References 23 publications

A meta-analysis of weekly cisplatin versus three weekly cisplatin chemotherapy plus concurrent radiotherapy (CRT) for advanced head and neck cancer (HNC)

A meta-analysis of weekly cisplatin versus three weekly cisplatin chemotherapy plus concurrent radiotherapy (CRT) for advanced head and neck cancer (HNC)

Treatment de-intensification strategies for head and neck cancer

Comparing high‐dose cisplatin with cisplatin‐based combination chemotherapy in definitive concurrent chemoradiation setting for locally advanced head and neck squamous cell carcinoma (LAHNSCC)

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