Randomized trial on acute toxicities of weekly vs three‐weekly cisplatin‐based chemoradiation in head and neck cancer

Abstract

Background: The current first-line treatment of locally advanced head and neck carcinoma (LAHNC) is concurrent chemoradiation with three-weekly cisplatin 100 mg/m 2 . However, prescribing cisplatin at this dose increases the treatment toxicity, which may compromise the treatment results. An alternative schedule is weekly 40 mg/m 2 cisplatin.Aim: To compare the acute hematologic and renal toxicities of these two regimens.Methods: This randomized clinical trial included 77 LAHNC patients who were allocated to a high dose (100 mg/m 2 every 3 weeks) or low dose (40 mg/m 2 weekly) cisplatin group concurrent with radiotherapy. Hematologic and renal indices were measured weekly during chemoradiation. Results:The average age of patients was 55.3 years. Overall, 71.4% of patients were treated in a definitive setting. The incidence of severe hematologic events was not significantly different. However, the average estimated glomerular filtration rate (eGFR) was significantly greater in the three-weekly group (67.85 vs. 58.57% mL/min per 1.73 m 2 ; P-value = .02). Cumulative cisplatin dose of ≥240 mg/m 2 was significantly greater in the weekly group. Totally, treatment breaks occurred in 40.3% of patients due to treatment toxicity. Treatment interruption was primarily due to neutropenia in the three-weekly and renal dysfunction and thrombocytopenia in the weekly group.Conclusions: Severe acute hematologic toxicities were comparable for three-weekly and weekly groups. The decrease in eGFR through treatment was more significant with weekly cisplatin. Further follow-up, however, is needed to confirm its impact on delayed renal function.

Concurrent Chemoradiotherapy With Weekly Low-Dose Cisplatin for Japanese Patients With Head and Neck Squamous Cell Carcinoma

“…13 After their report was published in mid-2000s, many reports have compared tri-weekly HDC and weekly LDC administrations directly and assessed the superiority in terms of outcomes and AEs that appeared in some journals. 4,5,14-19 Oosting et al 4 compared patients with high-risk postoperative HNSCC treated in 2 different tertiary cancer centres with different institutional practices: one centre used CRT with HDC[tri-weekly 100 mg/m 2 ] and the other used CRT with LDC [weekly 50 mg/m 2 ]. The mean cumulative cisplatin dose and the rate of cumulative cisplatin ⩾200 mg/m 2 were 239.8 mg/m 2 % and 85.2% in a centre using LDC, while those using HDC were 199.4 mg/m 2 % and 67.7%, respectively.…”

“…In the previous studies, HDC tended to lead to a higher rate of acute renal toxicity than LDC; 5,15,16 however, 1 paper from Iran reported that renal dysfunction was observed more in LDC group than HDC group. 14 This issue may depend on dietary habit or water intake of people of the nation.…”

Precision medicine for risk prediction of oral complications of cancer therapy–The example of oral mucositis in patients receiving radiation therapy for cancers of the head and neck

“…While some have reported that mucositis (all grades qw 61.2 vs. q3w 87.6%; severe qw 12.1 vs. q3w 34%) was more common and severe with high dose cisplatin [25]. In contrast, no differences in either incidence or intensity of mucositis have been reported in other trials in which the tumor impact of the two regimens was evaluated for both oral/oropharyngeal cancers [26][27][28]. The results of a recently reported Phase 2 interventional trial in which trained evaluators scored mucositis throughout treatment agrees with that conclusion [8].…”

Nonsurgical Treatment Strategies for Elderly Head and Neck Cancer Patients: An Emerging Subject Worldwide

“…There may be some tendency to show higher severe myelosuppression rate in triweekly cisplatin treated group. However, most reports demonstrated only the rate of severe myelosuppression and median/mean age of participants [ 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 ], which made it difficult to clearly evaluate the effects of triweekly/weekly cisplatin for older patients ( Table 2 ). It seems that the use of chemotherapy for the elderly will increase more and more in near future.…”