title: High-dose or low-dose cisplatin concurrent with radiotherapy in locally advanced head and neck squamous cell cancer.
abstract: No randomized studies have compared low-dose or high-dose concurrent chemoradiotherapy (CRT).
  
  
  
  In this study, 7219 patients with stage III or IV head and neck squamous cell carcinoma (HNSCC) were enrolled and categorized into 2 groups: group 1, comprising those undergoing low-dose concurrent CRT (n = 1575), and group 2, comprising those receiving high-dose concurrent CRT (n = 5644).
  
  
  
  Cox regression analyses revealed that age ≥65 years, male, high Charlson comorbidity index (CCI) scores, radiotherapy (RT) duration ≥7.5 weeks, clinical stage IV cancer, oral cavity cancers, tobacco smoking, and total cisplatin dose ≥240 mg/m2were significant independent prognostic risk factors for overall survival (OS). After adjustment for confounders, the adjusted hazard ratio (aHR; 95% confidence interval [CI]) for overall mortality was 0.83 (0.78-0.89; P < .001) in patients with oral cavity HNSCC undergoing high-dose concurrent CRT and 0.82 (0.77-0.94; P < .001) in patients with nonoral cavity HNSCC receiving high-dose concurrent CRT.
  
  
  
  High-dose concurrent CRT can reduce the incidence of death in patients with stage III or IV HNSCC.
authors.affiliation: Department of Hemato-Oncology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
authors.forename: Chia-Lun
authors.initials: CL
authors.lastname: Chang
authors.affiliation: Department of Otorhinolaryngology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
authors.forename: Kevin Sheng-Po
authors.initials: KS
authors.lastname: Yuan
authors.affiliation: Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan.|Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.|Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.|Department of Biotechnology, Hungkuang University, Taichung, Taiwan.
authors.forename: Szu-Yuan
authors.identifier: 0000-0001-5637-558X
authors.initials: SY
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods; D002945:Cisplatin / Q000008:administration & dosage*; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000503:physiopathology; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D016019:Survival Analysis; D013624:Taiwan; D016896:Treatment Outcome
chemical_list: D002945:Cisplatin
keywords: concurrent chemoradiotherapy (CRT); head and neck cancer; high dose; low dose; prognostic factors