3-weekly or weekly cisplatin concurrently with radiotherapy for patients with squamous cell carcinoma of the head and ne
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RESEARCH
Open Access
3-weekly or weekly cisplatin concurrently with radiotherapy for patients with squamous cell carcinoma of the head and neck – a multicentre, retrospective analysis Seth Helfenstein1, Oliver Riesterer2, Urs R. Meier3, Alexandros Papachristofilou4, Benjamin Kasenda1, Miklos Pless5† and Sacha I. Rothschild1*†
Abstract Background: Concurrent chemoradiotherapy with cisplatin is standard for patients (pts) with loco-regionally advanced squamous cell carcinoma of the head and neck (LA-SCCHN) and for patients with resected SCCHN with high-risk features. The standard regimen includes 3-weekly cisplatin, but weekly regimens are often used to lower toxicity. Reaching a cumulative dose of ≥200 mg/m2 cisplatin was shown being associated with improved outcome. We herein investigated cumulative dose reached and toxicities between the 3-weekly and weekly cisplatin regimens with concurrent radiotherapy. Methods: Multicentre, retrospective analysis of all patients undergoing combined RCT with cisplatin treated at 3 centres in Switzerland between 06/2008 and 12/2015. Results: Three hundred fourteen pts. were included (3-weekly, N = 127; weekly, N = 187). Median cumulative cisplatin dose was 200 mg/m2 (IQR 150–300) for pts. treated with a 3-weekly schedule and 160 mg/m2 (120–240) for the weekly schedule, consequently more pts. treated with a 3-weekly schedule reached a cumulative dose ≥200 mg/m2 (75.6% vs. 47.1%, p < 0.001). This association was also observed in multivariable analysis adjusted for age and sex (OR 3.46, 95% confidence interval [CI], 2.1–5.7). The 3-weekly regimen led to a higher rate of acute renal toxicity (33.1% vs. 20.9%, p = 0.022). In the landmark analysis, we could not confirm that a cisplatin dose ≥200 mg/m2 is associated with better survival (HR 1.3, 95% CI 0.8–1.9). Conclusions: Significantly more patients receive a cumulative cisplatin dose of ≥200 mg/m2, when treated with a 3-weekly schedule compared to weekly dosing. The previously reported association between a cumulative cisplatin dose ≥200 mg/m2 and improved outcome could not be shown in our study. Keywords: Head and neck squamous carcinoma, Chemo-radiotherapy, Treatment, Cisplatin, Dose
Background Prognosis of patients with squamous cell carcinoma of the head and neck (SCCHN) has improved in the last decades [1–4]. However, most SCCHN patients are diagnosed with loco-regionally advanced (LA-SCCHN) stage disease. In this setting, multimodal therapy including combined * Correspondence: [email protected] † Miklos Pless and Sacha I. Rothschild are contributed equally. 1 Department Internal Medicine, University Hospital Basel, Medical Oncology, Petersgraben 4, 4031 Basel, Switzerland Full list of author information is available at the end of the article
radiochemotherapy (RCT) either as adjuvant therapy after tumor resection or as definitive curatively intended treatment approach is recommended. Several Phase III randomized trials confirmed improved loco-regional control and longer survival for high-risk patients with combined
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