Download PDF
CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2017; 21(02): 171-177
DOI: 10.1055/s-0036-1594020
Original Research
Thieme-Revinter Publicações Ltda Rio de Janeiro, Brazil

Primary Concurrent Chemoradiation in Head and Neck Cancers with Weekly Cisplatin Chemotherapy: Analysis of Compliance, Toxicity and Survival

Muhammad Shahid Iqbal
1   Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
,
Cheng Chaw
2   Department of Clinical Oncology, Ninewells Hospital, Dundee, Dundee, United Kingdom of Great Britain and Northern Ireland
,
Josef Kovarik
1   Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
,
Shahzeena Aslam
3   Department of Clinical Oncology, Clinical Oncology, Addenbrookes Hospital, Cambridge, Cambridgeshire, United Kingdom of Great Britain and Northern Ireland
,
Aaron Jackson
4   Department of Research, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
,
John Kelly
1   Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
,
Werner Dobrowsky
1   Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
,
Charles Kelly
1   Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
› Author Affiliations
Further Information

Publication History

11 April 2016

09 September 2016

Publication Date:
19 December 2016 (online)

   Permissions and Reprints

Abstract

Introduction Concurrent chemoradiation is the standard of care in inoperable locally advanced squamous cell head and neck cancers. The most widely accepted schedule of concomitant cisplatin is 100mg/m2 given on a 3 weekly basis but the optimal regime is unknown.

Objective The objective of this study is to assess the tolerability, compliance, and clinical outcomes of weekly cisplatin (40mg/m2).

Methods During the period of January 2007–December 2009, we analyzed retrospectively 122 patients with histologically proven squamous cell carcinoma of head and neck (nasopharynx, oropharynx, larynx, hypopharynx, and oral cavity) treated with definitive chemoradiation. All patients received 63 Gy in 30 daily fractions with concomitant weekly cisplatin 40mg/m2. We assessed treatment toxicities and patient compliance. We estimated overall survival using the Kaplan-Meier method.

Results Sixty-eight percent of patients managed to complete all six cycles of chemotherapy while 87% of patients completed at least 5 cycles of weekly cisplatin. Incidence of grade 3/4 toxicity was as follows: mucositis 33%, dermatitis 41%, dysphagia 15%, mouth/neck pain 17%, neutropenia 2%, and renal impairment 3%. 53% patients required at least one hospital admission for symptom control. The 5-year overall survival rate was 60%.

Conclusion Concurrent chemoradiotherapy using weekly cisplatin at 40mg/m2 per week is an effective, well tolerated regimen allowing most patients to receive at least 5 cycles of chemotherapy. However, a phase III randomized control trial comparing the standard dose of 100mg/m2 cisplatin tri-weekly with a weekly regimen is needed to establish the long term clinical outcome.

Keywords

head and neck neoplasms - chemoradiotherapy - cisplatin
 

  • References

  • 1 Parkin DM, Bray F, Ferlay J, Pisani P. Estimating the world cancer burden: Globocan 2000. Int J Cancer 2001; 94 (02) 153-156
    CrossrefGoogle Scholar
  • 2 Pignon JP, le Maître A, Maillard E, Bourhis J. ; MACH-NC Collaborative Group. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol 2009; 92 (01) 4-14
    CrossrefGoogle Scholar
  • 3 Adelstein DJ, Li Y, Adams GL. , et al. An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol 2003; 21 (01) 92-98
    CrossrefGoogle Scholar
  • 4 Bernier J, Domenge C, Ozsahin M. , et al; European Organization for Research and Treatment of Cancer Trial 22931. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 2004; 350 (19) 1945-1952
    CrossrefGoogle Scholar
  • 5 Cooper JS, Pajak TF, Forastiere AA. , et al; Radiation Therapy Oncology Group 9501/Intergroup. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 2004; 350 (19) 1937-1944
    CrossrefGoogle Scholar
  • 6 Fountzilas G, Skarlos D, Kosmidis P. , et al. Radiation therapy and concurrent cisplatin administration in locally advanced head and neck cancer. A Hellenic Co-operative Oncology Group study. Acta Oncol 1994; 33 (07) 825-830
    CrossrefGoogle Scholar
  • 7 https://www.rtog.org/ResearchAssociates/AdverseEventReporting/CooperativeGroupCommonToxicityCriteria.aspx
  • 8 Marcu L, van Doorn T, Olver I. Cisplatin and radiotherapy in the treatment of locally advanced head and neck cancer--a review of their cooperation. Acta Oncol 2003; 42 (04) 315-325
    CrossrefGoogle Scholar
  • 9 Forastiere AA, Goepfert H, Maor M. , et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 2003; 349 (22) 2091-2098
    CrossrefPubMedGoogle Scholar
  • 10 de Castro Jr G, Snitcovsky IM, Gebrim EM. , et al. High-dose cisplatin concurrent to conventionally delivered radiotherapy is associated with unacceptable toxicity in unresectable, non-metastatic stage IV head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol 2007; 264 (12) 1475-1482
    CrossrefGoogle Scholar
  • 11 Machtay M, Moughan J, Trotti A. , et al. Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol 2008; 26 (21) 3582-3589
    CrossrefGoogle Scholar
  • 12 Homma A, Inamura N, Oridate N. , et al. Concomitant weekly cisplatin and radiotherapy for head and neck cancer. Jpn J Clin Oncol 2011; 41 (08) 980-986
    CrossrefGoogle Scholar
  • 13 Jeremic B, Shibamoto Y, Milicic B. , et al. Hyperfractionated radiation therapy with or without concurrent low-dose daily cisplatin in locally advanced squamous cell carcinoma of the head and neck: a prospective randomized trial. J Clin Oncol 2000; 18 (07) 1458-1464
    CrossrefGoogle Scholar
  • 14 Boulmay BC, Riggs CE, Lawson M, Morris C, Mendenhall WM. Validation of weekly-dose cisplatin combined with radiation therapy in locally advanced head and neck cancer [abstract]. Proc Am Soc Clin Oncol 2007; 25 (18S): 6076
    Google Scholar
  • 15 Hoebers FJ, Heemsbergen W, Balm AJ, van Zanten M, Schornagel JH, Rasch CR. Concurrent chemoradiation with daily low dose cisplatin for advanced stage head and neck carcinoma. Radiother Oncol 2007; 85 (01) 42-47
    CrossrefGoogle Scholar
  • 16 Lau H, Brar S, Hao D, MacKinnon J, Yee D, Gluck S. Concomitant low-dose cisplatin and three-dimensional conformal radiotherapy for locally advanced squamous cell carcinoma of the head and neck: Analysis of survival and toxicity. Head Neck 2006; 28 (03) 189-196
    CrossrefGoogle Scholar
  • 17 Huguenin P, Beer KT, Allal A. , et al. Concomitant cisplatin significantly improves locoregional control in advanced head and neck cancers treated with hyperfractionated radiotherapy. J Clin Oncol 2004; 22 (23) 4665-4673
    CrossrefGoogle Scholar
  • 18 Newlin HE, Amdur RJ, Riggs CE, Morris CG, Kirwan JM, Mendenhall WM. Concomitant weekly cisplatin and altered fractionation radiotherapy in locally advanced head and neck cancer. Cancer 2010; 116 (19) 4533-4540
    CrossrefGoogle Scholar
  • 19 Traynor AM, Richards GM, Hartig GK. , et al. Comprehensive IMRT plus weekly cisplatin for advanced head and neck cancer: the University of Wisconsin experience. Head Neck 2010; 32 (05) 599-606
    PubMedGoogle Scholar
  • 20 Sharma A, Mohanti BK, Thakar A, Bahadur S, Bhasker S. Concomitant chemoradiation versus radical radiotherapy in advanced squamous cell carcinoma of oropharynx and nasopharynx using weekly cisplatin: a phase II randomized trial. Ann Oncol 2010; 21 (11) 2272-2277
    CrossrefGoogle Scholar
  • 21 Gupta T, Agarwal JP, Ghosh-Laskar S, Parikh PM, D'Cruz AK, Dinshaw KA. Radical radiotherapy with concurrent weekly cisplatin in loco-regionally advanced squamous cell carcinoma of the head and neck: a single-institution experience. Head Neck Oncol 2009; 1: 17
    CrossrefGoogle Scholar
  • 22 Boulmay BC, Chera BS, Morris CG. , et al. Definitive altered fractionation radiotherapy and concomitant weekly cisplatin for locally advanced head and neck cancer. Am J Clin Oncol 2009; 32 (05) 488-491
    CrossrefGoogle Scholar
  • 23 Medina JA, Rueda A, de Pasos AS. , et al. A phase II study of concomitant boost radiation plus concurrent weekly cisplatin for locally advanced unresectable head and neck carcinomas. Radiother Oncol 2006; 79 (01) 34-38
    CrossrefGoogle Scholar
  • 24 Beckmann GK, Hoppe F, Pfreundner L, Flentje MP. Hyperfractionated accelerated radiotherapy in combination with weekly cisplatin for locally advanced head and neck cancer. Head Neck 2005; 27 (01) 36-43
    CrossrefGoogle Scholar
  • 25 Uygun K, Bilici A, Karagol H. , et al. The comparison of weekly and three-weekly cisplatin chemotherapy concurrent with radiotherapy in patients with previously untreated inoperable non-metastatic squamous cell carcinoma of the head and neck. Cancer Chemother Pharmacol 2009; 64 (03) 601-605
    CrossrefGoogle Scholar
  • 26 Geeta SN, Padmanabhan TK, Samuel J, Pavithran K, Iyer S, Kuriakose MA. Comparison of acute toxicities of two chemotherapy schedules for head and neck cancers. J Cancer Res Ther 2006; 2 (03) 100-104
    CrossrefGoogle Scholar
  • 27 Ho KF, Swindell R, Brammer CV. Dose intensity comparison between weekly and 3-weekly Cisplatin delivered concurrently with radical radiotherapy for head and neck cancer: a retrospective comparison from New Cross Hospital, Wolverhampton, UK. Acta Oncol 2008; 47 (08) 1513-1518
    CrossrefGoogle Scholar
  • 28 Lee JY, Sun JM, Oh DR. , et al. Comparison of weekly versus triweekly cisplatin delivered concurrently with radiation therapy in patients with locally advanced nasopharyngeal cancer: A multicenter randomized phase II trial (KCSG-HN10-02). Radiother Oncol 2016; 118 (02) 244-250
    CrossrefGoogle Scholar
  • 29 Rivelli TG, Mak MP, Martins RE, da Costa e Silva VT, de Castro Jr G. Cisplatin based chemoradiation late toxicities in head and neck squamous cell carcinoma patients. Discov Med 2015; 20 (108) 57-66
    PubMedGoogle Scholar