Quality of life in patients with locally advanced head and neck squamous cell carcinoma undergoing concurrent chemoradiation withonce‐a‐weekversusonce‐every‐3‐weekscisplatin

Abstract

Introduction This trial was conducted to compare the efficacy of low dose once‐a‐week cisplatin and once‐every‐3‐weeks cisplatin with radiation in locally advanced head and neck squamous cell carcinoma (LAHNSCC). The current analysis focuses on the quality of life (QoL) of patients in this trial. Methods In this phase III randomized trial, patients with nonmetastatic LAHNSCC were randomized to receive cisplatin 30 mg/m2 once‐a‐week or 100 mg/m2 once every‐ 3‐weeks concurrently with radiotherapy. The primary endpoint was locoregional control. QoL was a key secondary endpoint. QoL was assessed using EORTC QLQ‐C30 and QLQ‐H&N35. QoL data were assessed at baseline, days 22 and 43 during treatment; and at 6, 12, 24 months. The linear mixed‐effects model was used for longitudinal analysis of QoL to determine the impact of treatment (arm) and time on QoL. Results Three hundred patients were enrolled, data of 150 patients with available baseline QoL were analyzed. There was no significant difference in the global health status/QoL of the two treatment arms (p = 0.8664). There was no significant difference in the longitudinal QoL scores between the two treatment arms in all scales except constipation (p = 0.0096), less sexuality (p = 0.0002,), and financial difficulty (p = 0.0219). There was a worsening of the QoL scores in all scales in both arms during treatment, which improved after treatment completion in most scales. Conclusion The use of once‐every‐3‐weeks cisplatin did not adversely impact QoL as compared to once‐a‐week cisplatin in combination with radiotherapy in LAHNSCC.

Quality of life following treatment with intra-arterial cisplatin with concurrent radiation and erlotinib for locally advanced head and neck cancer

“…However, Le et al did not find a difference in overall survival benefit in adding erlotinib to platinum–docetaxel chemotherapy vs placebo in patients amenable for surgical resection [ 39 ]. Therefore, as newer studies have suggested modification or de-escalation of treatment regimens to help reduce their impact on the patients’ QoL [ 7 ], it is of particular importance to have proper patient selection as some trials have failed to improve outcomes while trying to produce less toxicity [ 15 ]. For instance, patients that are HPV-positive have been shown to have a better response to chemoradiotherapy than patients that are HPV-negative [ 40 – 42 ].…”

“…Many studies have shown that the addition of several non-invasive treatments may have a synergic effect in the overall survival of patients [ 4 – 6 ]. However, new studies have focused on modifying treatment regimens to not only increase survival, but to also reduce toxic effects [ 7 ]. Therefore, there is a fine line to decide if another combination of agents should be added or if the current regimen should be modified instead.…”

Survival Benefit from Cancer‐Directed Surgery for Metastatic Head and Neck Cancer

“…6 According to a previous study by Patel et al, they found that surgery with radiotherapy was associated with better mean survival (39.93 vs. 18.03 months, p < 0.0001) than radiotherapy alone in M1 HNC. 7 Unfortunately, previous studies have been mainly focused on the quality of life (QOL) in patients with advanced HNC, [8][9][10][11][12] but little has been performed to identify subgroups of patients who will benefit most from cancer-directed surgery (CDS) treatment. In addition, the standard treatment for patients with advanced nasopharyngeal carcinoma is radiotherapy or combined with chemotherapy, and surgery is not recommended.…”