Comparison of standard-dose 3-weekly cisplatin and low-dose weekly cisplatin for concurrent chemoradiation of patients with locally advanced head and neck squamous cell cancer

Abstract

Standard treatment for locally advanced (stage III-IV) head and neck squamous cell cancer (LA-HNSCC) is concurrent chemoradiation therapy (CCRT) with cisplatin 100 mg/m every 3 weeks. For medically unfit patients susceptible to treatment-related adverse events, low-dose weekly cisplatin (30-40 mg/m) can be used as an alternative. In this study, we retrospectively compared the therapeutic outcomes of low-dose weekly cisplatin regimen and standard regimen in CCRT for LA-HNSCC.The medical records of histologically confirmed LA-HNSCC patients were retrospectively reviewed from January 1, 2007 to December 31, 2012. Patients who were treated with CCRT as initial treatment were included.Among 220 patients eligible, 65 (29.5%) were treated with cisplatin dosing schedule of 100 mg/m every 3 weeks and 155 (70.5%) with 30 to 40 mg/m weekly. The overall response rate in 3-weekly group was 92.3% and did not differ from that in weekly group (91.0%). The median progression-free survival of the weekly group was not attained but was not significantly different from that of 3-weekly group (50.7 months, 95% confidence interval [CI] 42.2-59.1 months) (P = .81). Also, the median overcall survival did not differ significantly between 2 groups (P = .34).In the present study, low-dose weekly cisplatin showed therapeutic outcomes comparable to standard-dose cisplatin in CCRT for LA-HNSCC. Prospective comparison of standard-dose three-weekly and low-dose weekly cisplatin is warranted.

Matched pair analysis for comparison of survival outcome of alternative regimens to standard three-weekly cisplatin-based concurrent chemoradiation of head and neck cancer

“…Low-dose cisplatin (LDC) (30-50 mg/m 2 given once weekly) regimens show promising LRC, OS, and cancerspecific survival (CSS) with acceptable rate of severe acute toxicity (9)(10)(11). Several retrospective analyses suggest comparable efficacy and improved toxicity profile with LDC (12)(13)(14)(15). Three randomized trials, however, report conflicting data that HDC versus LDC (16,17) and LDC versus HDC (18) is superior in the post-operative setting.…”

Treatment strategy and outcomes in locally advanced head and neck squamous cell carcinoma: a nationwide retrospective cohort study (KCSG HN13–01)

“…Given that 3-weekly cisplatin was associated with significantly more toxicity than weekly -cisplatin, tolerability is a key factor in selection. Preference for weekly cisplatin in our study reflects the physicians' tendency to value safety [19,20]. For postoperative CCRT in high-risk disease, a recent phase III study, conducted at a single institution in India, demonstrated that two-year locoregional control was superior in patients receiving 100 mg/m 2 cisplatin every 3 weeks compared with 30 mg/m 2 cisplatin weekly (73.1% vs. 58.5%, p = 0.014) [6].…”

Nimotuzumab for Patients With Inoperable Cancer of the Head and Neck

“…In this controlled study, median PFS of the weekly group was not different to the high dose group (p = 0.81) (71). The 3-year overall survival and PFS were similar between the groups (71).…”