Hyperfractionated accelerated radiotherapy in combination with weekly cisplatin for locally advanced head and neck cancer

Beckmann, Gabriele; Hoppe, Florian; Pfreundner, Leo; Flentje, Michael

doi:10.1002/hed.20111

Cited by 69 publications

(64 citation statements)

References 34 publications

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“…[38][39][40][41] Recent literature suggests that a combination of alternative fractionation with concomitant chemotherapy significantly improves results and could become the treatment of choice for locally advanced head and neck cancer. [42][43][44][45]54 Therefore, altered fractionation regimens remain an important topic of research.…”

Section: Discussionmentioning

confidence: 99%

Early experience with a hybrid accelerated radiotherapy schedule for locally advanced head and neck cancer

Nuyts¹,

Dirix²,

Hermans³

et al. 2007

Head & Neck

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Section: Discussionmentioning

confidence: 99%

Early experience with a hybrid accelerated radiotherapy schedule for locally advanced head and neck cancer

Nuyts¹,

Dirix²,

Hermans³

et al. 2007

Head & Neck

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“…Several studies have reported on the use of weekly low-dose CDDP plus RT for LASCCHN (11)(12)(13). Although there are no head-to-head randomized studies directly compared tri-weekly CDDP plus RT with weekly CDDP plus RT for LASCCHN, weekly CDDP plus RT seems to have less renal toxicity (Grade 3 or 4 in 0%) (11,13) and neurotoxicity (Grade 3 or 4 in 0-3%) (11,13) than tri-weekly CDDP plus RT (Grade 3 or 4 renal toxicity in 2-9%, Grade 3 or 4 neurotoxicity in 7%) (1,14,15). However, it is unclear whether weekly CDDP plus RT for our study population is safe or not.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of concurrent carboplatin plus radiotherapy for locally advanced head and neck cancer patients ineligible for treatment with cisplatin

Hamauchi

Yokota

Onozawa

et al. 2015

Jpn. J. Clin. Oncol.

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Objective: Cisplatin-based chemoradiotherapy is the standard treatment for patients with locally advanced squamous cell carcinoma of the head and neck. However, patients with advanced age, renal, cardiac or neurogenic dysfunction seem ineligible for cisplatin treatment. We evaluated the safety and efficacy of concurrent carboplatin plus radiotherapy in patients ineligible for cisplatin usage. Methods: We retrospectively analyzed the records of 25 consecutive locally advanced squamous cell carcinoma of the head and neck patients who received concurrent carboplatin plus radiotherapy at Shizuoka Cancer Center between August 2006 and March 2014. Carboplatin was administered triweekly or weekly. Results: Patient characteristics were analyzed. The median age was 75 years (range, 54-82), male: female ratio, 24:1; performance status, 0-1 (23) or 2 (2); primary tumor site, oropharynx (10), hypopharynx (12), larynx (1) or oral cavity (2); Stage III (3), IVa (19) or IVb (3); induction chemotherapy, with (2) or without (23); and a median creatinine clearance of 62 ml/min (range, 37-117). The main reasons for choosing carboplatin were age (40%), renal impairment (36%) and cardiac dysfunction (20%). All patients received a planned irradiation dose of 70 Gy. Median follow-up was 30.9 months. Complete response was observed 70% patients. Median progression-free survival duration was 42.7 months. Median overall survival could not be analyzed. The 2-year progression-free and overall survival rates were 68 and 74%, respectively. The main toxicity Grade 3 or 4 was oral mucositis (56%), thrombocytopenia (34%), neutropenia (28%) and infection (24%). Conclusions: Concurrent carboplatin plus radiotherapy is tolerated and may be an option in treating locally advanced squamous cell carcinoma of the head and neck patients ineligible for treatment with cisplatin.

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“…Despite improved survival and LRC compared to radiotherapy alone compliance with CRT regimens is suboptimal in many cases [1]. To limit toxicity, alternative schedules with reduced single doses of cisplatin have been established in HNSCC patients like 20 mg/m 2 d1-5 (week 1 and 5) [2,23], weekly 30 or 40 mg/m 2 [5,17] or even daily 6 mg/m 2 of cisplatin [18,26], but to date published data are comparably rare. Common to all schedules is the aim to achieve a cumulative cisplatin dose of at least 200 mg/m 2 (CisCD200), although the adequacy of this threshold dose remains to be proven.…”

Section: Introductionmentioning

confidence: 99%

Chemoradiotherapy with Weekly Cisplatin 40 mg/m2 in 103 Head-and-Neck Cancer Patients

et al. 2009

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Background and Purpose:In patients with head-and-neck cancer treated with chemoradiotherapy (CRT), a cisplatin-based regimen is often used. Several treatment schedules are accepted with a cumulative cisplatin dose of 200 mg/m 2 (CisCD200) given during radiotherapy. The aim of this analysis was to investigate feasibility and efficacy of a weekly cisplatin 40 mg/m 2 regimen. Patients and Methods: During 08/2001 and 12/2006, 103 patients with squamous head-and-neck cancer received concurrent CRT with intended weekly cisplatin 40 mg/m 2 and were analyzed retrospectively. CRT was definitive for a newly diagnosed primary in 62, postoperative in 16, and for recurrence in 25 patients. Most patients had carcinoma of the hypo-and oropharynx (81%). Patients received a median total dose of 70 Gy (range, 42-71.2 Gy). Results: Only 42 patients (41%) received a CisCD200 predominantly due to hematotoxicity. Actuarial 12-and 18-month overall survival (OS) for patients with and without CisCD200 was 83.3% versus 72.1% (p = 0.19) and 66.7% versus 67.2% (p = 0.86), the 12-and 18-month locoregional control (LRC) 66.7% versus 78.7% (p = 0.325) and 59.5% versus 78.7% (p = 0.109), respectively. Multivariate analysis revealed only type of CRT (definitive vs. recurrent) and T-classification as significant variables predicting OS and LRC. Conclusion: Feasibility and efficacy of CRT with weekly cisplatin 40 mg/m 2 were suboptimal in this analysis. However, the prospects of weekly cisplatin may be its more suitable integration into emerging trimodality concepts combining CRT with molecularly targeted agents. Radiochemotherapie mit wöchentlichenCisplatingaben von 40 mg/m 2 bei 103 Patienten mit Kopf-Hals-Tumoren. Kumulative Cisplatindosis und Überleben Hintergrund und Ziel: Bei der Radiochemotherapie (CRT) von Patienten mit Kopf-Hals-Tumoren wird häufig eine platinhaltige Chemotherapie gewählt. Verschiedene Behandlungsschemata zielen auf eine kumulative Dosis von mindestens 200 mg/m 2 Cisplatin (CisCD200) simultan zur Bestrahlung. Ziel dieser Studie war es, die Wirksamkeit und Verträglichkeit wöchentlicher Cisplatingaben von 40 mg/m 2 zu untersuchen. Patienten und Methodik: Im Zeitraum von 08/2001 bis 12/2006 erhielten 103 Patienten mit Kopf-Hals-Tumoren eine CRT mit geplanten wöchentlichen Cisplatingaben von 40 mg/m 2 und wurden retrospektiv ausgewertet. 62 Patienten bekamen eine definitive CRT bei primär diagnostizierten Tumoren, 16 Patienten wurden postoperativ und 25 Patienten in einer Rezidivsituation behandelt. Hypo-oder Oropharynxkarzinome lagen in 81% (Tabelle 1) der Fälle vor. Die mediane Gesamtdosis betrug 70 Gy (Streubreite 42-71,2 Gy, Tabelle 2). Ergebnisse: Nur 42 Patienten (41%) erreichten die CisCD200 (Tabelle 3), hauptsächlich aufgrund erhöhter Hämatotoxizität. Das Gesamtüberleben (OS) nach 12 und 18 Monaten (Abbildung 1) betrug für die Patienten mit und ohne CisCD200 83,3% versus 72,1% (p = 0,19) und 66,7% versus 67,2% (p = 0,86). Die lokoregionäre Kontrolle (LRC) betrug nach 12 und 18 Monaten (Abbildung 2) 66,7% versus 78,7% ...

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Hyperfractionated accelerated radiotherapy in combination with weekly cisplatin for locally advanced head and neck cancer

Abstract: HFRCB in combination with weekly cisplatin achieves a high rate of locoregional control and survival. Four weekly cycles of 40 mg/m2 cisplatin seem to be the dose limit for most patients.

Cited by 69 publications

References 34 publications

Early experience with a hybrid accelerated radiotherapy schedule for locally advanced head and neck cancer

Early experience with a hybrid accelerated radiotherapy schedule for locally advanced head and neck cancer

Safety and efficacy of concurrent carboplatin plus radiotherapy for locally advanced head and neck cancer patients ineligible for treatment with cisplatin

Chemoradiotherapy with Weekly Cisplatin 40 mg/m2 in 103 Head-and-Neck Cancer Patients

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