title: Dose delivery analysis of weekly versus 3-weekly cisplatin concurrent with radiation therapy for locally advanced nasopharyngeal carcinoma (NPC).
abstract: OBJECTIVE
  The purpose of this study was to analyze the dose delivery and toxicity of weekly cisplatin versus high-dose cisplatin given every 3 weeks in a tertiary oncology clinic.
  
  
  METHODS
  From January 2000 to July 2009, patients with biopsy-proven nasopharyngeal carcinoma receiving concurrent cisplatin with curative-intent radiation therapy (RT) were included. Before 2005, most patients received cisplatin (Q3) (100 mg/m intravenously days 1, 22, and 43 of RT) and 3-dimensional conformal RT (66 Gy, 33 fractions). After 2005, most patients received weekly cisplatin (Q1) (40 mg/m intravenously weekly for 7 wk of RT) and intensity-modulated radiotherapy (70 Gy, 35 fractions).
  
  
  RESULTS
  Seventy-three patients were analyzed: 45 for Q1 and 28 for Q3. Cumulative doses ≥200 mg/m were achieved in 80% of Q1 and 86% of Q3 patients, respectively. Dose reduction due to toxicity was required in 2/45 (4%) of Q1 patients compared with 11/28 (39%) of Q3 patients (P=0.0003). Toxicities in Q1 and Q3 patients included: hospitalization for acute toxicity in 20% and 35.7%; mean weight loss 10.85% and 8.75%; percutaneous endoscopic gastrostomy tube placement in 25.6% and 29.6%; and grade 3 dehydration in 11.1% and 17.9%, respectively. Median follow-up time was 3 years for Q1 and 6 years for Q3 patients. Median disease-free survival was 46 months for the Q1 group and 53 months for the Q3 group (P=0.667). There was no difference in overall survival between Q1 and Q3.
  
  
  CONCLUSIONS
  In this series, weekly 40 mg/m cisplatin and 3-weekly 100 mg/m cisplatin showed similar deliverability, toxicity profiles, and outcomes. At our center, weekly cisplatin is standard of care for patients with locally advanced nasopharyngeal carcinoma undergoing chemoradiotherapy.
authors.affiliation: *Department of Medicine, University of British Columbia Departments of †Medical Oncology §Radiation Oncology, British Columbia Cancer Agency, Vancouver, BC ‡Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada.
authors.forename: Amanda
authors.initials: A
authors.lastname: Jagdis
authors.forename: Janessa
authors.initials: J
authors.lastname: Laskin
authors.forename: Desiree
authors.initials: D
authors.lastname: Hao
authors.forename: John
authors.initials: J
authors.lastname: Hay
authors.forename: Jonn
authors.initials: J
authors.lastname: Wu
authors.forename: Cheryl
authors.initials: C
authors.lastname: Ho
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002277:Carcinoma; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage* / Q000009:adverse effects; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D009367:Neoplasm Staging; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin