Comparison of four cisplatin-based radiochemotherapy regimens for nonmetastatic stage III/IV squamous cell carcinoma of the head and neck

Dirk Rades, Stefanie Kronemann, Thekla Meyners, Guenther Bohlen, Silke Tribius, Nadja Kazic, Ursula Schroeder, Samer G. Hakim, Steven E. Schild, Juergen Dunst

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Abstract

Purpose: To compare the outcomes of four cisplatin-based radiochemotherapy regimens in 311 patients with Stage III/IV squamous cell carcinoma of the head and neck. Methods and Materials: Concurrent chemotherapy consisted of three courses of cisplatin 100 mg/m2 on Day 1 (Group A, n = 74), two courses of cisplatin 20 mg/m2 on Days 1-5 plus 5-fluorouracil 1,000 mg/m2 on Days 1-5 (Group B, n = 49), two courses of cisplatin 20 mg/m2 on Days 1-5 plus 5-fluorouracil 600 mg/m2 on Days 1-5 (Group C, n = 102), or two courses of cisplatin 20 mg/m2 on Days 1-5 (Group D, n = 86). The groups were retrospectively compared for toxicity and outcomes, and 11 additional factors were evaluated for outcomes. Results: No significant difference was observed among the groups regarding radiation-related acute oral mucositis and radiation-related late toxicities. Acute Grade 3 skin toxicity was significantly more frequent in Group B than in the patients of the other three groups (p = .013). The chemotherapy-related Grade 3 nausea/vomiting rate was 24% for Group A, 8% for Group B, 9% for Group C, and 6% for Group D (p = .003). The corresponding Grade 3 nephrotoxicity rates were 8%, 1%, 2%, and 1% (p = .019). The corresponding Grade 3-4 hematologic toxicity rates were 35%, 41%, 19%, and 21% (p = .027). Chemotherapy could be completed in 50%, 59%, 74%, and 83% of the Group A, B, C, and D patients, respectively (p = .002). Toxicity-related radiotherapy breaks occurred in 39%, 43%, 21%, and 15% of Groups A, B, C, and D, respectively (p = .005). The 3-year locoregional control rate was 67%, 72%, 60%, and 59% for Groups A, B, C, and D, respectively (p = .48). The corresponding 3-year metastasis-free survival rates were 67%, 74%, 63%, and 79% (p = .31), and the corresponding 3-year survival rates were 60%, 63%, 50%, and 71% (p = .056). On multivariate analysis, Karnofsky performance status, histologic grade, T/N category, preradiotherapy hemoglobin level, completion of chemotherapy, and radiotherapy breaks were associated with the outcome. Conclusion: The four compared radiochemotherapy regimens were not significantly different regarding treatment outcomes. Two courses of cisplatin 20 mg/m2 on Days 1-5 were better tolerated than the other three regimens.

Original languageEnglish (US)
Pages (from-to)1037-1044
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume80
Issue number4
DOIs
StatePublished - Jul 15 2011

Keywords

  • Cisplatin-based radiochemotherapy
  • Head-and-neck cancer
  • Toxicity
  • Treatment outcomes

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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    Rades, D., Kronemann, S., Meyners, T., Bohlen, G., Tribius, S., Kazic, N., Schroeder, U., Hakim, S. G., Schild, S. E., & Dunst, J. (2011). Comparison of four cisplatin-based radiochemotherapy regimens for nonmetastatic stage III/IV squamous cell carcinoma of the head and neck. International Journal of Radiation Oncology Biology Physics, 80(4), 1037-1044. https://doi.org/10.1016/j.ijrobp.2010.03.033