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?

Dirk Rades; Daniel Seidl; Stefan Janssen; Amira Bajrovic; Samer G Hakim; Barbara Wollenberg; Katarina Karner; Primoz Strojan; Steven E Schild

doi:10.1016/j.oraloncology.2016.06.004

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?

Oral Oncol. 2016 Aug:59:67-72. doi: 10.1016/j.oraloncology.2016.06.004.

Authors

Dirk Rades¹, Daniel Seidl², Stefan Janssen³, Amira Bajrovic⁴, Samer G Hakim⁵, Barbara Wollenberg⁶, Katarina Karner⁷, Primoz Strojan⁷, Steven E Schild⁸

Affiliations

¹ Department of Radiation Oncology, University of Lübeck, Lübeck, Germany. Electronic address: Rades.Dirk@gmx.net.
² Department of Radiation Oncology, University of Lübeck, Lübeck, Germany.
³ Department of Radiation Oncology, University of Lübeck, Lübeck, Germany; Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany.
⁴ Department of Radiation Oncology, University Medical Center Eppendorf, Hamburg, Germany.
⁵ Department of Oral and Maxillofacial Surgery, University of Lübeck, Germany.
⁶ Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University of Lübeck, Germany.
⁷ Department of Radiotherapy, Institute of Oncology, Ljubljana, Slovenia.
⁸ Department of Radiation Oncology, Mayo Clinic Scottsdale, AZ, USA.

PMID: 27424184
DOI: 10.1016/j.oraloncology.2016.06.004

Abstract

Objectives: 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).

Materials and methods: 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.

Results: 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).

Concluding statement: 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.

Keywords: Adverse events; Chemoradiation; Higher-dose cisplatin; LASCCHN; Lower-dose fractionated cisplatin; Treatment outcomes.

Publication types

Comparative Study

MeSH terms

Antineoplastic Combined Chemotherapy Protocols
Carcinoma, Squamous Cell / therapy*
Chemoradiotherapy*
Cisplatin / administration & dosage*
Female
Head and Neck Neoplasms / therapy*
Humans
Male
Middle Aged
Retrospective Studies
Treatment Outcome

Substances

Cisplatin