Conventional Radiotherapy with Concurrent Weekly Cisplatin in Locally Advanced Head and Neck Cancers of Squamous Cell Origin - a Single Institution Experience

Abstract

Background: Platinum based concurrent chemo-radiation is the de-facto standard of care in the non-surgical management of locally-advanced head and neck cancer of squamous origin. Three-weekly single agent cisplatin at 100 mg/m 2 concurrent with radical radiotherapy has demonstrated consistent improvement in loco-regional control and survival. This improvement is however at the cost of considerable hematologic toxicity and poor overall compliance. The routine use of this regime is improbable in developing countries with limited resources. We therefore aimed to determine the safety and efficacy of an alternative regime of weekly cisplatin and concurrent radiotherapy in such patients. Materials and Methods: January-05 and April-12, 188 patients of locally-advanced head and neck cancer of squamous origin were treated with concurrent weekly-cisplatin at 35mg/m 2 and conventional radiotherapy 60-66Gy/30-33 fractions/5days per week. Results: Overall, 95% patients received planned doses of RT while 74% completed within the stipulated overall treatment time of <50 days. Eighty-two percent received at-least 5 weekly cycles. Grade-III/IV mucositis was seen in 58%/9% respectively, which resulted in mean weight loss of 9.2% from a pre-treatment mean of 54.5 kg. Grade-III hematologic toxicity-0.5%; grade II nephrotoxicity-2.5% and grade III emesis-3% were also seen. Grade-III/IV subcutaneous toxicity-10%/1% and grade-III/IV xerostomia-10%/0% were observed. Complete responses at the primary site, regional nodes and overall disease were seen in 86%, 89% and 83% patients respectively. The median and 5-years disease-free survival were 26 months and 39.4% respectively, while the median and overall survival were 27 months and 41.8% respectively. Conclusions: Weekly-cisplatin at 35 mg /m2 when delivered concurrently with conventional radical RT (at-least 66y/33 fractions) in locally-advanced head and neck cancer is well tolerated with minimal hematologic and neprologic toxicity and can be routinely delivered on an out-patient basis. It is an effective alternative to the standard 3-weekly cisplatin especially in the context of developing countries.

Whole-liver Radiotherapy Concurrent with Chemotherapy as a Palliative Treatment for Colorectal Patients with Massive and Multiple Liver Metastases: a Retrospective Study

“…A study reported that liver lesions could be boosted to a total of 83 Gy (Lausch et al, 2013). We found that conventional fraction intense-modulated radiotherapy reduced liver damage and encouraged more normal cell regeneration than hyperfractioned radiotherapy, according to radiation biology (Dimri et al, 2013). The use of IMRT may improve the ability to deliver high doses to the planned target volume while preserving the integrity of the surrounding normal tissues (Xiang et al, 2013).…”

Pu-erh Tea Powder Preventive Effects on Cisplatin-Induced Liver Oxidative Damage in Wistar Rats

“…Cisplatin (cis-diamminedichloroplatinumⅡ, CDDP) is one of the main chemotherapeutics, which is widely used for the treatment of various malignant solid tumors such as ovarian, lung, testicular and head and neck cancers (Pfister et al, 2010;Dimri et al, 2013; Dua et al, 2013;Besse et al, 2014 …”

“…Many studies have shown the effectiveness and feasibility of chemotherapy for cancers species involving the lung, pancreas, liver, large intestine, and so on. Conversely, treatment with anticancer drugs can also do harm to patients' normal tissues and organs, and those toxicities may lead to a worsened quality of life and shortened survival.Cisplatin (cis-diamminedichloroplatinumⅡ, CDDP) is one of the main chemotherapeutics, which is widely used for the treatment of various malignant solid tumors such as ovarian, lung, testicular and head and neck cancers (Pfister et al, 2010;Dimri et al, 2013; Dua et al, 2013;Besse et al, 2014 …”

The Indian scenario of head and neck oncology – Challenging the dogmas

“…Similar findings were reported by Dimri et al .,[ 36 ] who reported 188, Stage III/IV, treatment naive HNSCC patients (excluding nasopharynx and paranasal sinus) treated with weekly CDDP 35 mg/m 2 and RT to the dose of 60–66 Gy (at 2 Gy/fraction, 5 fractions per week).…”