Concomitant boost radiotherapy with concurrent weekly cisplatin in advanced head and neck cancers: a phase II trial

Kumar, Shaleen; Pandey, Manish Bhushan; Lal, Punita; Rastogi, Neeraj; Das, K.J. Maria; Dimri, Kislay

doi:10.1016/j.radonc.2004.12.004

Cited by 36 publications

(21 citation statements)

References 20 publications

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“…This suggests that our schedule was better than the weekly CDDP-40 mg/m 2 schedule in terms of compliance and hematologic toxicity and comparable in terms of survival outcomes. We have previously reported our experience with weekly CDDP at 35 mg/m 2 concurrent with concomitant boost RT in head and neck cancer (Kumar et al, 2005) and with conventional RT in oesophageal cancer (Kumar et al, 2002) and have achieved a favourable outcome.…”

Section: Discussionmentioning

confidence: 99%

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

Dimri¹,

Pandey²,

Trehan³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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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.

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Section: Discussionmentioning

confidence: 99%

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

Dimri¹,

Pandey²,

Trehan³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…The majority of research studies to date that have investigated the functional outcomes of AFRT on swallowing and nutrition have been confounded by the concurrent use of chemotherapy [11][12][13][14][15][16][17] . With the known exacerbation of toxicity associated with combined chemotherapy and radiotherapy 18,19 it is not adequate to assume the functional results following combined AFRT plus chemotherapy treatment would be equivalent to receiving AFRT alone.…”

Section: Introductionmentioning

confidence: 99%

A Prospective Investigation of Swallowing, Nutrition, and Patient-rated Functional Impact Following Altered Fractionation Radiotherapy with Concomitant Boost for Oropharyngeal Cancer

et al. 2011

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Altered fractionation radiotherapy for head and neck cancer has been associated with improved locoregional control, overall survival, and heightened toxicity compared with conventional treatment. Swallowing, nutrition and patient-perceived function for altered fractionation radiotherapy with concomitant boost (AFRT-CB) for T1-T3 oropharyngeal SCC has not been previously reported. Fourteen consecutive patients treated with AFRT-CB for oropharyngeal SCC were recruited from November 2006 to August 2009 in a tertiary hospital in Brisbane, Australia. Swallowing, nutrition and patient-perceived functional impact assessments were conducted pre-treatment, at 4-6 weeks post-treatment and at 6 months posttreatment. Deterioration from pre-treatment to 4-6 weeks post-treatment in swallowing, nutrition and functional impact was evident, likely due to the heightened toxicity associated with AFRT-CB. There was significant improvement at 6 months post-treatment in functional swallowing, nutritional status, patient-perceived swallowing and overall function, consistent with recovery from acute toxicity. However, weight and patient-perception of their physical function and side effects remained significantly worse than pre-treatment scores. The ongoing deficits related to weight and patient-perceived outcomes at 6 months revealed this treatment has a long-term impact on function possibly related to the chronic effects of AFRT-CB.

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“…This is especially true for developing countries like ours as has been highlighted by [38]. It may also lead to dropouts of patients in between the treatment and hence, poorer compliance.…”

Section: Discussionmentioning

confidence: 77%

Identification of Clinical and Pathological Parameters to Predict the Efficacy of Neoadjuvant Chemotherapy in Locally Advanced Oropharynxcancer - A Prospective Study

Kumari

2017

IJRRT

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The aim of the study is to evaluate the efficacy of Taxane based neoadjuvant chemotherapy in terms of tumor response and its effect on different morphological subtypes of oropharyngeal cancer followed by concurrent chemoradiotherapy in Indian scenario. Patients with locally advanced newly diagnosed, histological proven squamous cell carcinoma of the oropharynx were treated with neoadjuvant chemotherapy followed by concomitant chemoradiotherapy. These patients received treatment by 2D planning (Cobalt 60) method (two lateral opposed field and anterior neck) with shrinking field technique, total dose (60-70Gy) over 6-7 weeks interval by conventional fractionation along with concomitant chemotherapy Inj.cisplatin 30mg/ m 2 weekly. The primary end point was loco-regional response.The overall clinical RR after completion of 3 cycles of NACT was better than 2 cycles of NACT. Hence, it may be concluded that 3 cycles of NACT are better than 2 cycles but looking at OS and DFS 2 cycles appears to be better than 3 cycles with DFS and OS of 14.2 months and 18.4 months respectively, which is 8 months and 16.2 months with 3 cycles. As per stage, after 3 cycles of NACT the overall clinical RR in stage IV was (30.4%) and in stage III (21.7%) which is more than after 2 cycles, which again is an indicator of greater efficacy of 3 cycles then 2 cycles, but with limitations of smaller sample size and follow up duration.

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Concomitant boost radiotherapy with concurrent weekly cisplatin in advanced head and neck cancers: a phase II trial

Cited by 36 publications

References 20 publications

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

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

A Prospective Investigation of Swallowing, Nutrition, and Patient-rated Functional Impact Following Altered Fractionation Radiotherapy with Concomitant Boost for Oropharyngeal Cancer

Identification of Clinical and Pathological Parameters to Predict the Efficacy of Neoadjuvant Chemotherapy in Locally Advanced Oropharynxcancer - A Prospective Study

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