Radiotherapy potentiation with weekly cisplatin compared to standard every 3 weeks cisplatin chemotherapy for locoregionally advanced head and neck squamous cell carcinoma 

Abstract

BackgroundDespite its toxicity, cisplatin every 3 weeks (q3w) is the standard potentiation of chemo-radiotherapy for head and neck squamous cell carcinoma. This study aimed to determine whether weekly cisplatin (q1w) could be a safe and effective alternative.Patients and methodsTwo hundred and sixty-two patients with head and neck squamous cell carcinoma, irradiated in our institution with cisplatin (q1w or q3w) between January 2004 and December 2008, were retrospectively included. Overall survival (OS) and progression-free survival (PFS) were evaluated. Survival distributions were estimated by Kaplan–Meier method and compared using the log-rank test. Prognostic effect of chemo-radiotherapy was explored using Cox model.ResultsA total of 165 and 97 patients received q1w and q3w cisplatin, respectively. Median age, stage at diagnosis, alcohol consumption, intensity-modulated radiation therapy use, median weight, and renal failure before radiotherapy were significantly different, showing lower risk in the q3w group. Q3w cisplatin was found to be more toxic in terms of weight loss, renal failure, worse chemotherapy plan completion, and grade 3/4 mucositis and dermatitis, with more patients requiring analgesics, secondary hospitalization, and radiotherapy interruption (≥3 days), and patients affected by long-term toxicities. With a median follow-up of 73 months (95% confidence interval [CI] [68.9–76.2]), OS was found to be significantly better with q3w (5 years OS: 62.3%; 95% CI [51.6–71.3]) than with q1w cisplatin (5 years OS: 52.6%; 95% CI [44.5–60.0]) (log-rank P=0.0146). More number of patients treated according to the q1w schedule experienced a recurrence: 47.3% vs 30.9% (P=0.009). Thus, the PFS for q3w schedule was found to be globally better (5 years PFS: 55.8%; 95% CI [45.0–65.3]) than for q1w schedule (5 years PFS: 43.6%; 95% CI [35.9–51.0]) (log-rank P=0.0161). However, both multivariate analyses, OS and PFS, produce no significant hazard ratio for chemo-radiotherapy modality once adjusted on unbalanced covariates according to the descriptive analysis.ConclusionThough q1w seemed to be safer than q3w according to the descriptive analysis, multivariate analyses failed to conclude about its efficiency. Therefore, we conclude that the q3w schedule should remain the standard and prospective comparisons are needed.

Cisplatin Weekly Versus Every 3 Weeks Concurrently with Radiotherapy in the Treatment of Locally Advanced Head and Neck Squamous Cell Carcinomas: What Is the Best Dosing and Schedule?

“…Though level 1 evidence is lacking, weekly cisplatin has wide replaced the 3 weekly regimen in many clinical trials (Sharma et al, 2010; and in routine medical practice (Ho et al, 2008;Gupta et al 2009;Otty et al, 2011;Rawat et al, 2016;Rades et al, 2016;Fayette et al, Ghosh et al, 2015;Geeta et al, 2006;Oosting et al, 2016;Espeli et al, 2012;Geiger et al, 2014;Tsan et al, 2012;Sahoo et al, 2017;Quon et al, 2011). According to our results, we endorse using weekly cisplatin in view of the lower incidence of the acute toxicities compared to the high dose group.…”

Current treatment, particle radiotherapy, and boron neutron capture therapy for advanced oral cancer in patients

“…The 5‐year overall survival rate was 40% in the radiotherapy group and 53% in the combined therapy group, indicating that postoperative concurrent administration of high‐dose cisplatin with radiotherapy is more effective than radiotherapy alone and does not cause an unacceptable number of late complications. While concurrent chemoradiotherapy improves the outcomes of advanced cases, 16%‐57.8% of patients were reported to be unable to complete the systemic therapy portion of their treatment course due to treatment‐associated toxicities . Patients who did not complete chemotherapy showed a higher mortality rate (nonsignificant).…”

Topical issues of chemoradiotherapy for oropharyngeal squamous cell carcinoma: the efficiency and toxicity of chemotherapy regimens with the goal of radiomodification

“…[16] (33,3% против 40%), J. Fayette и соавт. [22] (мукозит 3-4-й степени 12,1% против 34%; p<0,001), и S. Rawat и соавт. [12] (70% против 75,9%; p=0,20) Тем не менее в некоторых исследованиях продемонстрирована более высокая частота развития мукозита 3-4-й степени при еженедельном введении цисплатина в сравнении с его введением 1 раз в 3 нед.…”

“…J. Fayette и соавт. [22] наблюдали мукозиты, дерматиты, тошнота/ рвота 3-4-й степени при введении цисплатина 1 раз в 3 нед соответственно в 34, 7,2 и 4,1% случаев, а при еженедельном режиме -в 12,1, 1,2 и 2,4%.…”