title: Chemoradiation of locally advanced squamous cell carcinoma of the head-and-neck (LASCCHN): Is 20mg/m(2) cisplatin on five days every four weeks an alternative to 100mg/m(2) cisplatin every three weeks?
abstract: To compare chemoradiation with 100mg/m(2) cisplatin every three weeks to 20mg/m(2) on five days every four weeks for locally advanced squamous cell carcinoma of the head-and-neck (LASCCHN).
  
  
  
  In 230 patients receiving chemoradiation for LASCCHN, 100mg/m(2) cisplatin every three weeks (N=126) and 20mg/m(2) cisplatin on five days every four weeks (N=104) were retrospectively compared. Chemoradiation plus eleven characteristics (T-/N-classification, performance score, gender, age, tumor site, grading, surgery, radiation technique, pre-chemoradiation hemoglobin, cumulative cisplatin dose) were analyzed for locoregional control (LRC), metastases-free survival (MFS) and overall survival (OS). Chemoradiation groups were compared for adverse events.
  
  
  
  On univariate analyses, chemoradiation had no impact on LRC (p=0.53), MFS (p=0.67) and OS (p=0.14). On multivariate analysis of LRC, T-classification (p=0.045) and hemoglobin (p<0.001) were significant. On multivariate analysis of MFS, performance score (p=0.028) was significant. On multivariate analysis of OS, performance score (p=0.009) and hemoglobin levels (p=0.002) achieved significance. Chemoradiation with 100mg/m(2) cisplatin was associated with more pneumonia/sepsis (p=0.003), grade ⩾2nausea/vomiting (p<0.001), grade ⩾2 nephrotoxicity (p=0.005), grade ⩾2 xerostomia (p=0.002), grade ⩾3 hematotoxicity (p=0.052) and grade ⩾2 ototoxicity (p=0.048).
  
  
  
  20mg/m(2) cisplatin on five days every four weeks was associated with fewer adverse events than 100mg/m(2) cisplatin every three weeks. 100mg/m(2) cisplatin was not significantly superior to 20mg/m(2) cisplatin regarding LRC, MFS and OS. Given the limitations of a retrospective study, 20mg/m(2) cisplatin appeared preferable. The results should be confirmed in a randomized trial.
authors.affiliation: Department of Radiation Oncology, University of Lübeck, Lübeck, Germany. Electronic address: Rades.Dirk@gmx.net.
authors.forename: Dirk
authors.initials: D
authors.lastname: Rades
authors.affiliation: Department of Radiation Oncology, University of Lübeck, Lübeck, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Seidl
authors.affiliation: Department of Radiation Oncology, University of Lübeck, 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 Oral and Maxillofacial Surgery, University of Lübeck, Germany.
authors.forename: Samer G
authors.initials: SG
authors.lastname: Hakim
authors.affiliation: Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University of Lübeck, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Wollenberg
authors.affiliation: Department of Radiotherapy, Institute of Oncology, Ljubljana, Slovenia.
authors.forename: Katarina
authors.initials: K
authors.lastname: Karner
authors.affiliation: Department of Radiotherapy, Institute of Oncology, 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: D000971:Antineoplastic Combined Chemotherapy Protocols; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage*; D005260:Female; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D002945:Cisplatin
keywords: Adverse events; Chemoradiation; Higher-dose cisplatin; LASCCHN; Lower-dose fractionated cisplatin; Treatment outcomes