Chemoradiotherapy with Weekly Cisplatin 40 mg/m2 in 103 Head-and-Neck Cancer Patients

A Cumulative Dose-Effect Analysis
  • Diana Steinmann
  • Bettina Cerny
  • Johann Hinrich Karstens
  • Michael Bremer
Original Article

Background and Purpose:

In patients with head-and-neck cancer treated with chemoradiotherapy (CRT), a cisplatin-based regimen is often used. Several treatment schedules are accepted with a cumulative cisplatin dose of 200 mg/m2 (CisCD200) given during radiotherapy. The aim of this analysis was to investigate feasibility and efficacy of a weekly cisplatin 40 mg/m2 regimen.

Patients and Methods:

During 08/2001 and 12/2006, 103 patients with squamous head-and-neck cancer received concurrent CRT with intended weekly cisplatin 40 mg/m2 and were analyzed retrospectively. CRT was definitive for a newly diagnosed primary in 62, postoperative in 16, and for recurrence in 25 patients. Most patients had carcinoma of the hypo- and oropharynx (81%). Patients received a median total dose of 70 Gy (range, 42–71.2 Gy).

Results:

Only 42 patients (41%) received a CisCD200 predominantly due to hematotoxicity. Actuarial 12- and 18-month overall survival (OS) for patients with and without CisCD200 was 83.3% versus 72.1% (p = 0.19) and 66.7% versus 67.2% (p = 0.86), the 12- and 18-month locoregional control (LRC) 66.7% versus 78.7% (p = 0.325) and 59.5% versus 78.7% (p = 0.109), respectively. Multivariate analysis revealed only type of CRT (definitive vs. recurrent) and T-classification as significant variables predicting OS and LRC.

Conclusion:

Feasibility and efficacy of CRT with weekly cisplatin 40 mg/m2 were suboptimal in this analysis. However, the prospects of weekly cisplatin may be its more suitable integration into emerging trimodality concepts combining CRT with molecularly targeted agents.

Key Words:

Chemoradiotherapy Head-and-neck cancer Cisplatin Cumulative dose 

Radiochemotherapie mit wöchentlichen Cisplatingaben von 40 mg/m2 bei 103 Patienten mit Kopf-Hals-Tumoren. Kumulative Cisplatindosis und Überleben

Hintergrund und Ziel:

Bei der Radiochemotherapie (CRT) von Patienten mit Kopf-Hals-Tumoren wird haufig eine platinhaltige Chemotherapie gewahlt. Verschiedene Behandlungsschemata zielen auf eine kumulative Dosis von mindestens 200 mg/m2 Cisplatin (CisCD200) simultan zur Bestrahlung. Ziel dieser Studie war es, die Wirksamkeit und Vertraglichkeit wochentlicher Cisplatingaben von 40 mg/m2 zu untersuchen.

Patienten und Methodik:

Im Zeitraum von 08/2001 bis 12/2006 erhielten 103 Patienten mit Kopf-Hals-Tumoren eine CRT mit geplanten wöchentlichen Cisplatingaben von 40 mg/m2 und wurden retrospektiv ausgewertet. 62 Patienten bekamen eine definitive CRT bei primar diagnostizierten Tumoren, 16 Patienten wurden postoperativ und 25 Patienten in einer Rezidivsituation behandelt. Hypo- oder Oropharynxkarzinome lagen in 81% (Tabelle 1) der Falle vor. Die mediane Gesamtdosis betrug 70 Gy (Streubreite 42–71,2 Gy, Tabelle 2).

Ergebnisse:

Nur 42 Patienten (41%) erreichten die CisCD200 (Tabelle 3), hauptsachlich aufgrund erhohter Hamatotoxizitat. Das Gesamtuberleben (OS) nach 12 und 18 Monaten (Abbildung 1) betrug fur die Patienten mit und ohne CisCD200 83,3% versus 72,1% (p = 0,19) und 66,7% versus 67,2% (p = 0,86). Die lokoregionare Kontrolle (LRC) betrug nach 12 und 18 Monaten (Abbildung 2) 66,7% versus 78,7% (p = 0,325) und 59,5% versus 78,7% (p = 0,109; Tabelle 4). In der Multivarianzanalyse hatten nur die Behandlungsart der CRT (Primar- vs. Rezidivbehandlung, Abbildung 3) und das T-Stadium signifikanten Einfluss auf OS und LRC (Tabelle 5).

Schlussfolgerung:

Die Durchfuhrbarkeit und Wirksamkeit der CRT mit wochentlichen Cisplatingaben erscheinen in dieser Analyse suboptimal. Der Vorteil wochentlicher Cisplatingaben liegt vor allem in der besseren Integrierbarkeit in Konzepte, die eine CRT mit einer zielgerichteten Therapie verbinden.

Schlüsselwörter:

Radiochemotherapie Kopf-Hals-Tumoren Cisplatin Kumulative Dosis 

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Copyright information

© Urban & Vogel, Muenchen 2009

Authors and Affiliations

  • Diana Steinmann
    • 1
    • 2
  • Bettina Cerny
    • 1
  • Johann Hinrich Karstens
    • 1
  • Michael Bremer
    • 1
  1. 1.Department of Radiation OncologyMedical School HannoverHannoverGermany
  2. 2.Department of Radiation OncologyMedical School HannoverHannoverGermany

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