Comparison of acute toxicities of two chemotherapy schedules for head and neck cancers.
BACKGROUND
Chemo-radiotherapy has become the standard of care for loco-regionally advanced head and neck cancers. Platinum based regimens are the most effective. Although benefits are proven with chemo-radiation, acute toxicities are markedly increased. The dose and delivery schedules of Cisplatin have ranged from intermittent higher dose [100 mg/m2] every 3 weeks to low dose [6 mg/m2] daily administration. At present there is no data indicating which regimen is superior.


OBJECTIVE
To compare acute toxicities of two chemotherapy schedules for head and neck cancers.


METHODS
A total of 83 head and neck cancer patients treated with two schedules of concurrent chemo RT were analyzed, retrospectively, for treatment toxicity. In group A [51 patients], chemotherapy [CT] was administered on week 1, 4 and 7 [cisplatin 100 mg/m2] over a period of 2-3 days. In group B [32 patients], CT was delivered weekly [cisplatin 40 mg/m2]. Radiotherapy dose was 7000 cGy in 35 fractions for definitive concurrent chemo-radiation and 6600 cGy in 33 fractions for adjuvant treatment.


RESULTS
Group B patients had increased grade III skin and hematological toxicity, where as patients in group A had more pharyngeal toxicity. Treatment interruptions and percentage of weight loss were higher in group B. Weekly CT schedule had higher rate of severe mucositis, which was statistically significant on both univariate [P = 0.005] and multivariate [P = 0.007] analysis.


CONCLUSIONS
Three weekly CT is less toxic than weekly. Weekly CT can be made more acceptable by reducing the dose and using feeding tubes for nutrition.
Geeta
S N
SN
Department of Radiation Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Padmanabhan
T K
TK
Samuel
J
J
Pavithran
K
K
Iyer
S
S
Kuriakose
M A
MA
D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000532:radiotherapy; D002945:Cisplatin / Q000008:administration & dosage* / Q000009:adverse effects*; D003131:Combined Modality Therapy; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy; D006801:Humans; D012189:Retrospective Studies
D000970:Antineoplastic Agents; D002945:Cisplatin