Concomitant infusion cisplatin and hyperfractionated radiotherapy for locally advanced nasopharyngeal and paranasal sinus tumors

Cisplatin and Radiotherapy in the Treatment of Locally Advanced Head and Neck Cancer

“…Marcial et al (26) evaluated the late toxicities in the 72% of treated patients that achieved a complete response, reporting 3% with necrosis, 4% with fibrosis and 8% with other toxicities (otitis, paresthesia, dental caries). Choi et al (4) reported minimal late toxicity consisting of mild fibrosis, xerostomia, otitis and dental caries with no severe toxicities being reported at follow-up. Late high-grade toxicity was observed in Jeremic et al's (5) trial where xerostomia was manifested in 22% of the patients and subcutaneous toxicities in 12% of the patients after receiving combined treatment.…”

“…Owing to the high toxicity of cisplatin, the side effects were mainly anticipated, although in some trials the complications exceeded the expectations (22,31). In other cases, interruptions in treatment were necessary because of excessive toxicity (3,4,23).…”

“…Current trials tend to fractionate the drug dose with daily administration, leading to improved long-term benefits and better-tolerated treatment (4,5).…”

Intraarterial cisplatin with intravenous paclitaxel and ifosfamide as an organ‐preservation approach in patients with paranasal sinus carcinoma

“…17,18 High long-term disease control and survival rates in the range of 70 -90% were reported in two small, retrospective, consecutive series by investigators from the University of Chicago 19,20 in which a combination, neoadjuvant, cisplatin-based regimen was used followed by surgery and-or concomitant chemo-RT. The University of Chicago group previously reported a response rate of 80% (CR rate, 37.5%); a local control rate of 76.1% at 5 years and 10 years; noteworthy 5-year and 10-year survival rates of 72.7% and 53.9%, respectively; and a 66.6% disease-free survival rate at both 5 years and 10 years 20 with neoadjuvant cisplatin/5-fluorouracil (5-FU) chemotherapy followed by standard surgical resection and adjuvant, concomitant chemo-RT with a 1 week on/1 week off regimen using cisplatin, 5-FU, and hydroxyurea or standard RT, whereas Choi et al 21 reported a 94% CR rate and a 50% OS rate in 17 patients who were treated with hyperfractionated, concomitant chemo-RT.…”

“…17,18 High long-term disease control and survival rates in the range of 70 -90% have been reported in two small, retrospective, consecutive series by investigators from the University of Chicago 19,20 in which a neoadjuvant cisplatin-based regimen was used followed by surgery and/or concomitant chemo-RT. Finally, in a small series, Choi et al 21 reported a high complete response (CR) rate and modest long-term survival with concomitant, hyperfractionated chemo-RT. Based on the prior experience at our institution with IA chemotherapy for patients with paranasal sinus tumors 12,21 and the successful introduction of newer, active agents in systemic chemotherapy for patients with advanced head and neck squamous cell carcinomas, including the taxanes and ifosfamide, 22,23 we designed a trial introducing all of those elements to address locally advanced paranasal sinus squamous cell carcinomas in patients who would require orbital exenteration or major craniofacial resection to achieve complete resection of the tumor in an effort to maximize organ preservation.…”