Feasibility of concomitant cisplatin with hypofractionated radiotherapy for locally advanced head and neck squamous cell carcinoma

Abstract

BackgroundThe evolution of radiotherapy over recent decades has reintroduced the hypofractionation for many tumor sites with similar outcomes to those of conventional fractionated radiotherapy. The use of hypofractionation in locally advanced head and neck cancer (LAHNC) has been already used, however, its use has been restricted to only a few countries. The aim of this trial was to evaluate the safety and feasibility of moderate hypofractionated radiotherapy (HYP-RT) with concomitant cisplatin (CDDP).MethodsThis single-arm trial was designed to evaluate the safety and feasibility of HYP-RT with concomitant CDDP in LAHNC. Stage III and IV patients withnonmetastatic disease were enrolled. Patients were submitted to intensity modulatedradiation therapy, which comprised 55 Gy/20 fractions to the gross tumor and44–48 Gy/20 fractions to the areas of subclinical disease. Concomitant CDDPconsisted of 4 weekly cycles of 35 mg/m2. The primary endpoints were the treatment completion rate and acute toxicity.ResultsTwenty patients were enrolled from January 2015 to September 2016, and 12 (60%) were classified as unresectable. All patients completed the total dose of radiotherapy, and 19 patients (95%) received at least 3 of 4 cycles of chemotherapy. The median overall treatment time was 29 days (27–34). Grade 4 toxicity was reported twice (1 fatigue and 1 lymphopenia). The rates of grade 3 dermatitis and mucositis were 30% and 40%, respectively, with spontaneous resolution. Nasogastric tubes were offered to 15 patients (75%) during treatment; 4 patients (20%) needed feeding tubes after 2 months, and only 1 patient needed a feeding tube after 12 months.ConclusionHYP-RT with concomitant CDDP was considered feasible for LAHNC, and the rate of acute toxicity was comparable to that of standard concomitant chemoradiation. A feeding tube was necessary for most patients during treatment. Further investigation of this strategy is warranted.Trial registrationClinicalTrials, NCT03194061. Registered 21 Jun 2017 – Retrospectively registered.

Practice recommendations for risk-adapted head and neck cancer radiotherapy during the COVID-19 pandemic: An ASTRO-ESTRO consensus statement

“…For early larynx cancer (T1N0), 50 Gy/16 f was most commonly recommended, 8,9 and there are data for 55 Gy/20 f in T2N0 disease. 10,11 There is limited evidence to support the use of hypofractionated radical radiation therapy over 4 to 5 weeks for locoregionally advanced disease, but panelists suggested schedules, including 55 Gy/20 f, [12][13][14][15] 62.5-64 Gy/25 f, 16,17 and 54 Gy/18 f. 18,19 Most would not use concomitant chemotherapy in this setting, and there was agreement to restrict concomitant chemotherapy to schedules of 2.4 Gy/f. Although there are data to support the use of concomitant platinum chemotherapy with higher doses per fraction, 13,14,16 panelists expressed reservations about the potential lack of benefit (eg, no apparent local control or overall survival advantage from the combination of chemotherapy with accelerated radiation therapy) 20,21 and the risk of increased acute and late toxicities.…”

Hypofractionated chemoradiation for head and cancer: Data from the PET NECK trial

“…The 4 week regime 55 Gy in 20# over 25 days has historically been used with several single agents including methotrexate, cetuximab, carboplatin and capecitabine for locally advanced disease disease [28] , [29] , [30] , [31] , [32] , [33] . More recent IMRT series have used 55 Gy in 20 fractions with synchronous single agent cisplatin, carboplatin and cetuximab [13] , [34] , [35] . The number of patients treated with the 4 week regime and synchronous cisplatin or carboplatin in the PET NECK study is too small to draw conclusions and there remains the possibility of a type II error.…”

“…The number of patients treated with the 4 week regime and synchronous cisplatin or carboplatin in the PET NECK study is too small to draw conclusions and there remains the possibility of a type II error. The International Atomic Energy Agency is currently examining 4 week accelerated hypofractionated chemoradiation or radiation versus conventional fractionationed chemoradiation or radiation in a large international randomised trial [35] .…”

New Challenges of Treatment for Locally Advanced Head and Neck Cancers in the Covid-19 Pandemic Era

“…One of the characteristics of this disease is a favorable response to initial treatment but the rate of distant metastases is similar to that of HPV-oropharyngeal cancers. The inferior results given by the replacement of Cisplatin with Cetuximab in this category of patients and the increased risk of distant metastases highlight the role of systemic treatment in this subcategory of H&N [64][65][66][67][68].…”