Patient reported outcomes in patients with head and neck cancer treated with concurrent chemoradiation with weekly versus bolus cisplatin

Abstract

Background: Patient Reported Outcome (PRO) data comparing bolus (B-CP) with weekly (W-CP) cisplatin concurrent with radiation are lacking. Methods: We performed a retrospective study comparing PRO among 99 patients with head and neck radiation, 26% who received concurrent B-CP and 73% treated with W-CP. Results: W-CP patients had a higher Charlson comorbidity index (CCI) (P = .004). There were no differences in median cisplatin dose, PROs, percutaneous endoscopic gastrostomy (PEG) dependence or hospitalization between arms. Patients with a greater decline in their self-reported dysphagia score were more often PEG dependent at the end of radiation therapy (P = .03). There was also a trend toward PEG dependence with a higher maximum dysphagia score and greater change in aspiration score (P = .06). The maximum decline in white cell count and absolute neutrophil count were greater in the W-CP group (P = .04, P = .01). Conclusion: Both B-CP and W-CP are well tolerated. PROs do not suggest a benefit to W-CP. K E Y W O R D S bolus cisplatin, chemoradiation, head and neck cancer, patient reported outcome, weekly cisplatin 1 | INTRODUCTION Chemoradiation treatment for patients with head and neck cancer is morbid, with high rates of both acute and chronic toxicity that adversely impact patients' quality of life (QOL). 1-3 Xerostomia, mucositis, nausea, dysphagia, and loss of appetite are common. Percutaneous endoscopic gastrostomy (PEG) dependence has declined over time with the use of more advanced treatment techniques but is significantly more likely with the addition of radiosensitizing chemotherapy. 4,5 Conference presentation: ASTRO 2019, Chicago.

Three weekly versus weekly concurrent cisplatin: safety propensity score analysis on 166 head and neck cancer patients

“…Considering the patient reported outcomes, Arbab et al [ 9 ] performed a retrospective analysis on 99 patients (73 patients treated with a 1w schedule and 26 with a 3w). Results showed that patients reported outcome resulted to be comparable among the two cohorts of patients.…”

“…It could also reduce chemotherapy-related acute and late side effects, facilitate dose adjustments according to clinical conditions during the treatment and therefore outpatient management, with lower hospitalization rates. Several retrospective and prospective studies [ 6 – 9 ], as well as different systematic reviews and meta-analysis [ 10 – 13 ] comparing 1w- and 3w- schedules, showed conflicting and inconclusive results, both in terms of survival outcomes and toxicity profile. Indeed, while most of these studies confirmed that oncologic outcome seems to be similar between the two regimens, hematologic toxicity showed not homogeneous findings among the different analyzed cohort.…”

Association between radiation dose to organs at risk and acute patient reported outcome during radiation treatment for head and neck cancers

“…JMP Pro version 14.3, SAS Institute, Inc., Cary, NC and SAS 9.4 software, SAS Institute, Inc., Cary, NC were used for subsequent data analyses. Severity of scores were reported as mild (score 1–4), moderate (score 5–6) and severe (7–10) based on the maximum score of symptoms during radiation as per our previous analysis looking at PRO in relation to cisplatin schedule 24 . The association between maximum severity score group and dose to OARs was investigated by using Kruskal–Wallis test.…”

“…Severity of scores were reported as mild (score 1-4), moderate (score 5-6) and severe (7)(8)(9)(10) based on the maximum score of symptoms during radiation as per our previous analysis looking at PRO in relation to cisplatin schedule. 24 The association between maximum severity score group and dose to OARs was investigated by using Kruskal-Wallis test. Pearson correlation coefficients were calculated to study the relationship between maximum symptom scores and dose to OARs.…”