Comparing two lower-dose cisplatin programs for radio-chemotherapy of locally advanced head-and-neck cancers.
Radio-chemotherapy is a common treatment for locally advanced squamous cell head-and-neck cancers (LA-SCCHN). Cisplatin (100 mg/m2) every 3 weeks is very common but associated with considerable toxicity. Therefore, cisplatin programs with lower daily doses were introduced. There is a lack of studies comparing lower-dose programs. In this study, 85 patients receiving radio-chemotherapy with 20 mg/m2cisplatin on 5 days every 4 weeks (group A) were retrospectively compared to 85 patients receiving radio-chemotherapy with 30-40 mg/m2cisplatin weekly (group B). Groups were matched for nine factors including age, gender, performance score, tumor site, T-/N-category, surgery, hemoglobin before radio-chemotherapy, and radiation technique. One- and 3-year loco-regional control rates were 83 and 69 % in group A versus 74 and 63 % in group B (p = 0.12). One- and 3-year survival rates were 93 % and 73 % in group A versus 91 and 49 % in group B (p = 0.011). On multivariate analysis, survival was significantly better for group A (HR 1.17; p = 0.002). In groups A and B, 12 and 28 % of patients, respectively, did not receive a cumulative cisplatin dose ≥180 mg/m2(p = 0.016). Toxicity rates were not significantly different. On subgroup analyses, group A patients had better loco-regional control (p = 0.040) and survival (p = 0.005) than group B patients after definitive radio-chemotherapy. In patients receiving adjuvant radio-chemotherapy, outcomes were not significantly different. Thus, 20 mg/m2cisplatin on 5 days every 4 weeks resulted in better loco-regional control and survival in patients receiving definitive radio-chemotherapy and may be preferable for these patients. Confirmation of these results in a randomized trial is warranted.
Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany. Rades.Dirk@gmx.net.
Dirk
D
Rades
Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Daniel
D
Seidl
Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.|Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany.
Stefan
S
Janssen
Department of Radiotherapy, Institute of Oncology, Ljubljana, Slovenia.
Primoz
P
Strojan
Department of Radiotherapy, Institute of Oncology, Ljubljana, Slovenia.
Katarina
K
Karner
Department of Radiation Oncology, University Medical Center Eppendorf, Hamburg, Germany.
Amira
A
Bajrovic
Department of Oral and Maxillofacial Surgery, University of Lübeck, Lübeck, Germany.
Samer G
SG
Hakim
Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University of Lübeck, Lübeck, Germany.
Barbara
B
Wollenberg
Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA.
Steven E
SE
Schild
D000970:Antineoplastic Agents / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D002945:Cisplatin
LA-SCCHN; Loco-regional control; Lower-dose cisplatin; Radio-chemotherapy; Survival; Toxicity
Drug Des Devel Ther. 2015 Nov 26;9:6203-10
26648696
Strahlenther Onkol. 2013 Oct;189(10):856-60
23868550
Radiat Oncol. 2012 Dec 18;7:215
23245290
Eur Arch Otorhinolaryngol. 2007 Dec;264(12):1475-82
17643256
J Clin Oncol. 2000 Apr;18(7):1458-64
10735893
Oral Oncol. 2014 Apr;50(4):311-8
24467937
Radiother Oncol. 2009 Jul;92(1):4-14
19446902
Radiother Oncol. 1997 Apr;43(1):29-37
9165134
Cancer. 2007 Jan 1;109(1):48-53
17123270
J Clin Oncol. 2004 Dec 1;22(23):4665-73
15534360
Int J Radiat Oncol Biol Phys. 2011 Jul 15;80(4):1037-44
20638185
Acta Oncol. 2008;47(8):1513-8
18607863
N Engl J Med. 2004 May 6;350(19):1937-44
15128893
Head Neck. 2016 Apr;38 Suppl 1:E2151-8
25735803
Eur Arch Otorhinolaryngol. 2015 Dec;272(12):3805-14
25542247
J Clin Oncol. 2003 Jan 1;21(1):92-8
12506176
N Engl J Med. 2004 May 6;350(19):1945-52
15128894
N Engl J Med. 2003 Nov 27;349(22):2091-8
14645636
Oral Oncol. 2012 Mar;48(3):266-71
22079100