Comparison of acute toxicities in two primary chemoradiation regimens in the treatment of advanced head and neck squamous cell carcinoma.

Abstract

PURPOSE:

The optimal dosage and frequency of platinum-based chemoradiotherapy (CRT) regimen for treating advanced head and neck squamous cell carcinoma remains unresolved. This study aims to compare the toxicity and efficacy of weekly versus more dose-intensive cisplatin-based CRTs.

METHODS:

We reviewed 155 stage III/IV head and neck squamous cell carcinoma patients with no evidence of distant metastasis treated with one of two CRT regimens from 2000 to 2010 at Greater Baltimore Medical Center. Twice-daily radiation was provided as a split course over a 45-day period. Regimen A consisted of concomitant cisplatin (30 mg/m2/1 h) weekly for 6 cycles; regimen B consisted of concomitant cisplatin (12 mg/m2/1 h) and 5-fluorouracil (600 mg/m2/20 h) on days 1 through 5 and days 29 through 33. Main outcome measures included acute toxicities (myelosuppression, neurotoxicity, nephrotoxicity, gastrointestinal dysfunction), unplanned hospitalizations, and disease control at 12 months.

RESULTS:

Patients on regimen A were much less likely to experience ototoxicity due to their treatment (0% vs. 9.8%, P = 0.04). They were more likely to experience thrombocytopenia acutely (46% vs. 26%, P = 0.02), but the toxicity was not limiting (grade 1–2). No significant differences exist in the incidence of other toxicities or unplanned hospitalizations. At 1 year, 97% of patients on A vs. 86% of patients on regimen B were free of disease (P = 0.11).

CONCLUSIONS:

With concurrent radiotherapy, low-dose, single-agent, weekly cisplatin is less likely than higher-dose daily cisplatin plus 5-fluorouracil provided at the beginning and end of treatment to be associated with ototoxicity. The preliminary data suggest at least equivalent efficacy, but longer follow-up is required.

• Authors: Katherine Y Fan, Hrishikesh Gogineni, David Zaboli, Spencer Lake, Marianna L Zahurak, Simon R Best, Marshall A Levine, Mei Tang, Eva S Zinreich, John R Saunders, Joseph A Califano, Ray G Blanco, Sara I Pai, Barbara Messing, Patrick K Ha
• Journal: Annals of surgical oncology (Ann Surg Oncol) Vol. 19 Issue 6 Pg. 1980-7 (Jun 2012) ISSN: 1534-4681 [Electronic] United States
• PMID: 22290566 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Cisplatin
• Fluorouracil

Topics

• Acute Disease
• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols (adverse effects)
• Carcinoma, Squamous Cell (mortality, therapy)
• Chemoradiotherapy (adverse effects)
• Cisplatin (administration & dosage)
• Female
• Fluorouracil (administration & dosage)
• Follow-Up Studies
• Head and Neck Neoplasms (mortality, therapy)
• Hospitalization
• Humans
• Male
• Middle Aged
• Neoplasm Staging
• Prognosis
• Radiation Injuries (etiology)
• Retrospective Studies
• Survival Rate