The comparison of acute toxicity in 2 treatment courses

Abstract

The most appropriate cisplatin treatment schedule delivered with radiotherapy in patients with head and neck squamous cell carcinoma (HNSCC) is unknown. The aim of this study was to compare the acute toxicity and its impact on the course of the treatment, administered cisplatin and radiation doses, the length of hospitalization and supportive drugs administration in patients with HNSCC receiving 2 different cisplatin treatment schedules administered with radiotherapy.In this retrospective analysis, 104 patients with HNSCC were enrolled. Patients received radiation concurrently with 100 mg/m2 cisplatin administered 3-weekly (n = 50; group A) or 35 to 40 mg/m2 cisplatin administered weekly (n = 54; group B). Chemoradiotherapy was performed in locally and/or regionally advanced disease (stage III–IV), in a definitive radical upfront setting (71.1%) or after surgical resection in patients with high-risk factors (28.8%).Both study groups were equally distributed in terms of age, gender, stage of the disease, Eastern Cooperative Oncology Group performance score, chronic diseases and primary tumor site. The schedule of cisplatin dosing did not influence the duration of hospitalization, the number of additional supportive drugs (antibiotics, opioids) administered or total doses of received radiotherapy. However, postponement of radiotherapy due to adverse events was significantly more frequent in patients treated with 35/40 mg/m2 (55.56% vs 32%; P = .015). Furthermore, patients treated with weekly treatment schedule received lower total cisplatin dose (160 mg/m2) in comparison to those treated with the 3-weekly schedule (200 mg/m2). Grade 3 and 4 mucositis occurred more frequently in patients treated in group A (70% vs 50%; P = .037). Leukopenia was also observed more frequently in group A (88% vs 72.2%; P = .04), however there was no difference in grade 3/4 leukopenia between both study arms. There was no statistically significant difference in any other adverse effects.These results do not demonstrate the advantage of modified weekly schedule over standard 3-weekly cisplatin treatment plan. However, severe mucositis occurred more frequently in patients receiving 3-weekly cisplatin, both chemotherapy schedules seemed to present similar toxicity. Due to conflicting efficacy and toxicity, the results and compliance of weekly and 3-weekly cisplatin schedules should be evaluated in further randomized, controlled trials and retrospective studies.

Persistent and Chronic Postoperative Opioid Use in a Cohort of Patients with Oral Tongue Squamous Cell Carcinoma

“…Patients with oral tongue cancers may receive chemoradiation therapy after surgery to improve their survival [21,22]. Unfortunately, chemotherapy (i.e., cisplatin) and radiation may be associated with significant pain, such as severe neuropathies (4-71%), mucositis (26-41%), and dysphagia (12%), for which patients are treated with opioids, although with limited efficacy at the doses found in this study [6,[21][22][23][24][25][26]. Although Saraswathula et al found an association only between adjuvant radiotherapy and persistent postoperative opioid use and not with chemotherapy, Shah et al reported that patients with chemotherapy-induced peripheral neuropathies were twice as likely to receive opioids five years after treatment compared with those without the neuropathy [17,23].…”

Nimotuzumab for Patients With Inoperable Cancer of the Head and Neck

“…The trial included mainly patients with oropharyngeal tumors (60%) (75). In a secondary analysis of the trial including only patients with larynx or hypopharynx tumors, there were no differences in laryngeal preservation, laryngectomy free survival, and overall survival (65). In general, the combination of cetuximab and radiotherapy is prescribed to patients unfit to receive cisplatin and radiotherapy, provided that several trials, mainly done in the scenario of HPV positive oropharynx cancer, demonstrated that cetuximab/RT was inferior to cisplatin/RT (76)(77)(78).…”

“…Concurrent irradiation and chemotherapy is the recommended regimen for locally advanced SCCHN patients (65). The current standard protocol of chemo-radiotherapy, involves the use of radiotherapy concurrent with cisplatin bolus dose of 100 mg/m 2 infused every 21 days (65). Despite the good results with this protocol, treatment-related toxicity remains an important concern.…”

“…Despite the good results with this protocol, treatment-related toxicity remains an important concern. Unacceptable toxicity provokes a delay of the definitive radiotherapy, which, in turn, negatively affects the general therapeutic outcome, especially in elderly patients or in subjects with poor general conditions (65).…”

Metronomic Therapy in Oral Squamous Cell Carcinoma

“…Existence of cancer stem cells [22,23], increased angiogenesis [24,25], and unfavorable immune profile in the microenvironment [26,27] are the proposed mechanisms that contribute to platinum-resistant OCSCC and predict poor prognosis. Moreover, the MTD of cisplatin (100 mg/m 2 ) is deemed as a highly toxic regimen because it has significant side-effects such as nephrotoxicity, ototoxicity, and neurotoxicity [28,29]. Therefore, novel therapeutic strategies are necessary to improve OCSCC treatment outcomes a step further [30].…”