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Cisplatin superior to carboplatin in adjuvant radiochemotherapy for locally advanced cancers of the oropharynx and oral cavity

Cisplatin ist Carboplatin bei der adjuvanten Radiochemotherapie von lokal fortgeschrittenen Oropharynx- und Mundhöhlenkarzinomen überlegen

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Abstract

Background and purpose

The optimal radiochemotherapy regimen for squamous cell carcinoma of the head and neck (SCCHN) is controversial. In most cases, platin-based chemotherapy regimens are used. However, uncertainty exists whether cisplatin or carboplatin is the better choice. This retrospective study compared radiochemotherapy with either cisplatin or carboplatin in patients with locally advanced SCC of the oropharynx and oral cavity.

Patients and methods

Concurrent chemotherapy consisted of two courses of cisplatin (20 mg/m2 on days 1–5 and days 29 − 33; n = 65) or two courses of carboplatin (AUC 1.5 on days 1–5 and days  29 − 33; n = 41). Both regimens were retrospectively compared for locoregional control (LRC), overall survival (OS), and toxicity. Thirteen additional potential prognostic factors were evaluated including age, gender, ECOG performance status, tumor site, histologic grade, T/N category, AJCC stage, year of treatment, extent of resection, interval between surgery and RT, completion of chemotherapy, and radiotherapy breaks.

Results

The 3-year LRC rates were 85% in the cisplatin group and 62% in the carboplatin group, respectively (p = 0.004). The 3-year OS rates were 78% and 51%, respectively (p = 0.001). Acute toxicity (mucositis, skin toxicity, nausea/vomiting, renal toxicity, hematologic toxicity) and late toxicity (xerostomia, neck fibrosis, skin toxicity, lymph edema) rates were not significantly different between the two groups. On multivariate analysis, better LRC was significantly associated with cisplatin (p < 0.001), an ECOG performance status of 0–1 (p = 0.001), and an interval between surgery and RT of ≤ 6 weeks (p = 0.001). Improved OS was significantly associated with cisplatin (p < 0.001) and completion of chemotherapy (p = 0.002).

Conclusion

For adjuvant radiochemotherapy of patients with locally advanced cancer of the oropharynx and oral cavity, cisplatin appears preferable to carboplatin as it resulted in better outcomes without increased toxicity.

Zusammenfassung

Hintergrund und Ziel

Das optimale Radiochemotherapieregime bei der Behandlung von Kopf-Hals-Tumoren ist unklar. Zumeist werden platinhaltige Regime verwendet. Bisher wurde nicht hinreichend geklärt, ob Cisplatin oder Carboplatin die besser geeignete Substanz ist. Diese retrospektive Studie vergleicht jeweils die Radiochemotherapie (RT) mit Cisplatin und mit Carboplatin bei Patienten mit einem lokal fortgeschrittenen Plattenepithelkarzinom des Oropharynx oder der Mundhöhle.

Patienten und Methoden

Die simultane Chemotherapie beinhaltete entweder zwei Kurse Cisplatin (20 mg/m2 an den Tagen 1–5  und den Tagen  29 − 33; n = 65) oder zwei Kurse Carboplatin (AUC 1.5 an den Tagen 1–5  und den Tagen  29 − 33; n = 41). Beide Regime wurden für die lokoregionale Kontrolle (LRC), das Gesamtüberleben (OS) und Toxizitäten verglichen. Elf weitere Faktoren wurden untersucht: Alter, Geschlecht, Allgemeinzustand (ECOG), Tumorlokalisation, Grading, T- und N-Kategorie, AJCC-Stadium, Resektionsstatus, Vollständigkeit der Chemotherapie sowie die Notwendigkeit von Bestrahlungspausen.

Ergebnisse

Die 3-Jahres-Raten für die lokoregionale Kontrolle betrugen 85% in der Cisplatin-Gruppe und 62% in der Carboplatin-Gruppe (p = 0,004). Die 3-Jahres-Überlebensraten lagen bei 78% und 51% (p = 0,001). Akuttoxizität (Mukositis, Hauttoxizität, Übelkeit/Erbrechen, Hämatotoxizität) und Spättoxizität (Xerostomie, Fibrose, Hauttoxizität, Lymphödem) waren nicht signifikant unterschiedlich zwischen den beiden Kollektiven. In der multivariaten Analyse war eine bessere lokoregionale Kontrolle signifikant mit der Art der Chemotherapie (Cisplatin, p  <  0,001), einem besseren Allgemeinzustand (ECOG 0–1, p = 0,001) sowie einem Zeitraum zwischen der Operation und der RT von ≤ 6 Wochen (p = 0,001) assoziiert. Ein besseres Gesamtüberleben (OS) war signifikant mit der Art der Chemotherapie (Cisplatin, p < 0,001) und vollständiger Applikation der geplanten Chemotherapie (p = 0,002) assoziiert.

Schlussfolgerung

Bei der adjuvanten Radiochemotherapie von lokal fortgeschrittenen Oropharynx- und Mundhöhlenkarzinomen scheint Cisplatin gegenüber Carboplatin von Vorteil zu sein, da Cisplatin zu besseren Behandlungsergebnissen ohne erhöhte Toxizität führte.

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The corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, 23538, Lubeck, Germany

    D. Rades M.D.

  2. Department of Maxillofacial Surgery, University of Lubeck, Lubeck, Germany

    T. Ulbricht & S.G. Hakim

  3. Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA

    S.E. Schild

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  1. D. Rades M.D.
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  2. T. Ulbricht
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  3. S.G. Hakim
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  4. S.E. Schild
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Correspondence to D. Rades M.D..

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Rades, D., Ulbricht, T., Hakim, S. et al. Cisplatin superior to carboplatin in adjuvant radiochemotherapy for locally advanced cancers of the oropharynx and oral cavity. Strahlenther Onkol 188, 42–48 (2012). https://doi.org/10.1007/s00066-011-0005-z

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