Postoperative Radiochemotherapy With Weekly Cisplatin in Patients With Head and Neck Cancer Single-Institution Outcome Analysis

Abstract

The objective of this study was to evaluate the feasibility, toxicity and efficacy of postoperative radiochemotherapy with weekly cisplatin in locoregionally advanced or high risk head and neck cancer in a single institutional setting.Patients with head and neck cancer of stage III/IV or patients with insufficient margins of resection were included in the study. Radiotherapy consisted of 70 Gy/ 7 weeks/ 35 fraction after R1/2 resection and 60-64 Gy/ 6-6,5 weeks/ 30-32 fraction after R0 resection, respectively. All patients received concurrent cisplatin 40 mg/m 2 weekly. Between 7/2002 and 12/2008, 100 consecutive patients [WHO ≤ 2, male to female ratio 84/16, median age 54 years] were treated. Tumors of the oropharynx were the most frequent (49%) and stage IV was predominant (86%). 96% patients received the full radiation treatment as planned, median total tumor dose was 66 Gy. Omission of weekly cisplatin had been occurring frequently, the most frequent reason for its early cessation were hematological toxicities (34%). Grade 3/4 mucosal toxicity developed in 32%. No death was observed during the treatment. The late toxicities were acceptable, predominantly subcutaneous fibrosis and xerostomia in most of the cases. We recorded six cases of osteonecrosis. Two and half year overall survival, locoregional control, time to progression and disease free survival were 64%, 88%, 79% and 59%, respectively.Postoperative radiochemotherapy with weekly cisplatin is toxic, but tolerable and highly effective in terms of locoregional control and survival. Multivariete analysis revealed that the only prognostic factor for survival was primary surgery at the University centre.

Toxicity and efficacy of accelerated radiotherapy with concurrent weekly cisplatin for locally advanced head and neck carcinoma

“…In a study using the same accelerated RT schedule, we observed a similar incidence of confluent mucositis of 79%, which indicates that concomitant weekly cisplatin does not further enhance mucosal toxicity . Studies using conventional RT combined with weekly cisplatin showed 31% to 75% mucositis ≥ grade 3, but similar rates of hematological and renal toxicity as we found . Hospital admissions were required in 55% of our patients, 40% for acute reasons and 15% for logistical reasons.…”

Three Weekly Versus Weekly Cisplatin as Radiosensitizer in Head and Neck Cancer: a Decision Dilemma

“…Contrary to expectations, the incidence of treatment interruptions was significantly higher (41% vs 22%; p=0.005) in the weekly cisplatin arm (Geeta et al, 2006). Frequent omission of weekly cisplatin (40 mg/m 2 ) due to haematological toxicity has also been reported by Pala et al (2012). Similar to this, Mitra et al found more number of treatment interruptions in weekly CT group, which might be explained by higher percentage of patients with significant weight loss in the weekly group.…”

Improved overall survival and mortality in head and neck cancer with adjuvant concurrent chemoradiotherapy in national databases

“…Nine single-arm studies evaluated the efficacy of adjuvant CRT. [23][24][25][26][27][28][29][30][31] Of these, six were prospective trials. 23,24,26,28,30,31 Data gathered in these studies covered a period from 1980 to 2009.…”