Randomized trial on acute toxicities of weekly vs three-weekly cisplatin-based chemoradiation in head and neck cancer.

Abstract

BACKGROUND\nThe current first-line treatment of locally advanced head and neck carcinoma (LAHNC) is concurrent chemoradiation with three-weekly cisplatin 100\u2009mg/m2 . However, prescribing cisplatin at this dose increases the treatment toxicity, which may compromise the treatment results. An alternative schedule is weekly 40\u2009mg/m2 cisplatin.\n\n\nAIM\nTo compare the acute hematologic and renal toxicities of these two regimens.\n\n\nMETHODS\nThis randomized clinical trial included 77 LAHNC patients who were allocated to a high dose (100\u2009mg/m2 every 3\u2009weeks) or low dose (40\u2009mg/m2 weekly) cisplatin group concurrent with radiotherapy. Hematologic and renal indices were measured weekly during chemoradiation.\n\n\nRESULTS\nThe average age of patients was 55.3\u2009years. Overall, 71.4% of patients were treated in a definitive setting. The incidence of severe hematologic events was not significantly different. However, the average estimated glomerular filtration rate (eGFR) was significantly greater in the three-weekly group (67.85 vs. 58.57% mL/min per 1.73\u2009m2 ; P-value\xa0=\xa0.02). Cumulative cisplatin dose of ≥240\u2009mg/m2 was significantly greater in the weekly group. Totally, treatment breaks occurred in 40.3% of patients due to treatment toxicity. Treatment interruption was primarily due to neutropenia in the three-weekly and renal dysfunction and thrombocytopenia in the weekly group.\n\n\nCONCLUSIONS\nSevere acute hematologic toxicities were comparable for three-weekly and weekly groups. The decrease in eGFR through treatment was more significant with weekly cisplatin. Further follow-up, however, is needed to confirm its impact on delayed renal function.