Annals of Surgical Oncology

, Volume 19, Issue 6, pp 1980–1987

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

Authors

  • Katherine Y. Fan
    • Johns Hopkins University School of Medicine
  • Hrishikesh Gogineni
    • Case Western Reserve University School of Medicine
  • David Zaboli
    • Johns Hopkins University School of Medicine
  • Spencer Lake
    • Johns Hopkins University School of Medicine
  • Marianna L. Zahurak
    • Department of Oncology, Division of Oncology BiostatisticsJohns Hopkins Medical Institution
  • Simon R. Best
    • Department of Otolaryngology-Head and Neck SurgeryJohns Hopkins Medical Institution
  • Marshall A. Levine
    • Johns Hopkins University School of Medicine
    • Department of Medical Oncology, Sandra & Malcolm Berman Cancer InstituteGreater Baltimore Medical Center
  • Mei Tang
    • Department of Medical Oncology, Sandra & Malcolm Berman Cancer InstituteGreater Baltimore Medical Center
  • Eva S. Zinreich
    • Department of Radiation Oncology, Sandra & Malcolm Berman Cancer InstituteGreater Baltimore Medical Center
  • John R. Saunders
    • Milton J. Dance Jr. Head and Neck CenterGreater Baltimore Medical Center
  • Joseph A. Califano
    • Department of Otolaryngology-Head and Neck SurgeryJohns Hopkins Medical Institution
    • Milton J. Dance Jr. Head and Neck CenterGreater Baltimore Medical Center
  • Ray G. Blanco
    • Milton J. Dance Jr. Head and Neck CenterGreater Baltimore Medical Center
  • Sara I. Pai
    • Department of Otolaryngology-Head and Neck SurgeryJohns Hopkins Medical Institution
  • Barbara Messing
    • Milton J. Dance Jr. Head and Neck CenterGreater Baltimore Medical Center
    • Department of Otolaryngology-Head and Neck SurgeryJohns Hopkins Medical Institution
    • Milton J. Dance Jr. Head and Neck CenterGreater Baltimore Medical Center
Head and Neck Oncology

DOI: 10.1245/s10434-012-2219-4

Cite this article as:
Fan, K.Y., Gogineni, H., Zaboli, D. et al. Ann Surg Oncol (2012) 19: 1980. doi:10.1245/s10434-012-2219-4

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.

Copyright information

© Society of Surgical Oncology 2012