title: Comparison of weekly administration of cisplatin versus three courses of cisplatin 100 mg/m(2) for definitive radiochemotherapy of locally advanced head-and-neck cancers.
abstract: To compare definitive radiochemotherapy with weekly administration of 30-40 mg/m(2) of cisplatin to 100 mg/m(2) of cisplatin on days 1, 22 and 43 for outcomes and toxicity in patients with squamous cell carcinoma of the head-and-neck.
  
  
  
  Seventy-five patients receiving radiochemotherapy with weekly cisplatin (30-40 mg/m(2)) were compared to 58 patients receiving radiochemotherapy with 100 mg/m(2) cisplatin on days 1, 22 and 43. Radiochemotherapy regimen plus seven characteristics (age, gender, performance score, tumor site, T-/N-category, histologic grading) were evaluated for locoregional control (LRC), metastases-free survival (MFS) and overall survival (OS). Radiochemotherapy groups were compared for toxicity.
  
  
  
  On multivariate analysis, improved LRC was associated with cisplatin 100 mg/m(2) (hazard ratio [HR] 1.57; p = 0.008) and female gender (HR 4.37; p = 0.003). Radiochemotherapy regimen was not significantly associated with MFS on univariate analysis (p = 0.66). On multivariate analysis, better MFS was associated with ECOG performance score 0-1 (HR 5.63; p < 0.001) and histological grade 1-2 (HR 1.81; p = 0.002). On multivariate analysis, improved OS was associated with cisplatin 100 mg/m(2) (HR 1.33; p = 0.023), ECOG performance score 0-1 (HR 2.15; p = 0.029) and female gender (HR 1.98; p = 0.026). Cisplatin 100 mg/m(2) was associated with higher rates of grade ≥3 hematotoxicity (p = 0.004), grade ≥2 renal failure (p = 0.004) and pneumonia/sepsis (p = 0.033).
  
  
  
  Radiochemotherapy with 100 mg/m(2) of cisplatin every 3 weeks resulted in better LRC and OS than weekly doses of 30-40 mg/m(2). Given the limitations of a retrospective study, 100 mg/m(2) of cisplatin appears preferable. Since this regimen was associated with considerable acute toxicity, patients require close monitoring.
authors.affiliation: Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, D-23538, Lübeck, Germany. Rades.Dirk@gmx.net.
authors.forename: Dirk
authors.initials: D
authors.lastname: Rades
authors.affiliation: Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, D-23538, Lübeck, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Seidl
authors.affiliation: Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, D-23538, Lübeck, Germany.|Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Janssen
authors.affiliation: Department of Radiation Oncology, University Medical Center Eppendorf, Hamburg, Germany.
authors.forename: Amira
authors.initials: A
authors.lastname: Bajrovic
authors.affiliation: Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
authors.forename: Katarina
authors.initials: K
authors.lastname: Karner
authors.affiliation: Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
authors.forename: Primoz
authors.initials: P
authors.lastname: Strojan
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Schild
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000401:mortality; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: Adverse events; Cisplatin; Definitive treatment; Head-and-neck cancer; Outcomes; Radiochemotherapy