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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2012

01-06-2012 | Head and Neck Oncology

Comparison of Acute Toxicities in Two Primary Chemoradiation Regimens in the Treatment of Advanced Head and Neck Squamous Cell Carcinoma

Authors: Katherine Y. Fan, BS, Hrishikesh Gogineni, BS, David Zaboli, BS, Spencer Lake, BS, Marianna L. Zahurak, MS, Simon R. Best, MD, Marshall A. Levine, MD, Mei Tang, MD, Eva S. Zinreich, MD, John R. Saunders, MD, Joseph A. Califano, MD, Ray G. Blanco, MD, Sara I. Pai, MD, PhD, Barbara Messing, MA, CCC-SLP, Patrick K. Ha, MD

Published in: Annals of Surgical Oncology | Issue 6/2012

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Abstract

Purpose

The optimal dosage and frequency of platinum-based chemoradiotherapy (CRT) regimen for treating advanced head and neck squamous cell carcinoma remains unresolved. This study aims to compare the toxicity and efficacy of weekly versus more dose-intensive cisplatin-based CRTs.

Methods

We reviewed 155 stage III/IV head and neck squamous cell carcinoma patients with no evidence of distant metastasis treated with one of two CRT regimens from 2000 to 2010 at Greater Baltimore Medical Center. Twice-daily radiation was provided as a split course over a 45-day period. Regimen A consisted of concomitant cisplatin (30 mg/m2/1 h) weekly for 6 cycles; regimen B consisted of concomitant cisplatin (12 mg/m2/1 h) and 5-fluorouracil (600 mg/m2/20 h) on days 1 through 5 and days 29 through 33. Main outcome measures included acute toxicities (myelosuppression, neurotoxicity, nephrotoxicity, gastrointestinal dysfunction), unplanned hospitalizations, and disease control at 12 months.

Results

Patients on regimen A were much less likely to experience ototoxicity due to their treatment (0% vs. 9.8%, P = 0.04). They were more likely to experience thrombocytopenia acutely (46% vs. 26%, P = 0.02), but the toxicity was not limiting (grade 1–2). No significant differences exist in the incidence of other toxicities or unplanned hospitalizations. At 1 year, 97% of patients on A vs. 86% of patients on regimen B were free of disease (P = 0.11).

Conclusions

With concurrent radiotherapy, low-dose, single-agent, weekly cisplatin is less likely than higher-dose daily cisplatin plus 5-fluorouracil provided at the beginning and end of treatment to be associated with ototoxicity. The preliminary data suggest at least equivalent efficacy, but longer follow-up is required.
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Metadata
Title
Comparison of Acute Toxicities in Two Primary Chemoradiation Regimens in the Treatment of Advanced Head and Neck Squamous Cell Carcinoma
Authors
Katherine Y. Fan, BS
Hrishikesh Gogineni, BS
David Zaboli, BS
Spencer Lake, BS
Marianna L. Zahurak, MS
Simon R. Best, MD
Marshall A. Levine, MD
Mei Tang, MD
Eva S. Zinreich, MD
John R. Saunders, MD
Joseph A. Califano, MD
Ray G. Blanco, MD
Sara I. Pai, MD, PhD
Barbara Messing, MA, CCC-SLP
Patrick K. Ha, MD
Publication date
01-06-2012
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 6/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2219-4

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