Comparison of Acute Toxicities in Two Primary Chemoradiation Regimens in the Treatment of Advanced Head and Neck Squamous Cell Carcinoma

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• 作者：Katherine Y. Fan BS (1)
  Hrishikesh Gogineni BS (2)
  David Zaboli BS (1)
  Spencer Lake BS (1)
  Marianna L. Zahurak MS (3)
  Simon R. Best MD (4)
  Marshall A. Levine MD (1) (5)
  Mei Tang MD (5)
  Eva S. Zinreich MD (6)
  John R. Saunders MD (7)
  Joseph A. Califano MD (4) (7)
  Ray G. Blanco MD (7)
  Sara I. Pai MD ; PhD (4)
  Barbara Messing MA ; CCC-SLP (7)
  Patrick K. Ha MD (4) (7)
  
• 刊名：Annals of Surgical Oncology
• 出版年：2012
• 出版时间：June 2012
• 年：2012
• 卷：19
• 期：6
• 页码：1980-1987
• 全文大小：201KB
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• 作者单位：Katherine Y. Fan BS (1)
  Hrishikesh Gogineni BS (2)
  David Zaboli BS (1)
  Spencer Lake BS (1)
  Marianna L. Zahurak MS (3)
  Simon R. Best MD (4)
  Marshall A. Levine MD (1) (5)
  Mei Tang MD (5)
  Eva S. Zinreich MD (6)
  John R. Saunders MD (7)
  Joseph A. Califano MD (4) (7)
  Ray G. Blanco MD (7)
  Sara I. Pai MD, PhD (4)
  Barbara Messing MA, CCC-SLP (7)
  Patrick K. Ha MD (4) (7)
  
  1. Johns Hopkins University School of Medicine, Baltimore, MD, USA
  2. Case Western Reserve University School of Medicine, Cleveland, OH, USA
  3. Department of Oncology, Division of Oncology Biostatistics, Johns Hopkins Medical Institution, Baltimore, MD, USA
  4. Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institution, Baltimore, MD, USA
  5. Department of Medical Oncology, Sandra & Malcolm Berman Cancer Institute, Greater Baltimore Medical Center, Baltimore, MD, USA
  6. Department of Radiation Oncology, Sandra & Malcolm Berman Cancer Institute, Greater Baltimore Medical Center, Baltimore, MD, USA
  7. Milton J. Dance Jr. Head and Neck Center, Greater Baltimore Medical Center, Baltimore, MD, USA
  

文摘

Purpose The optimal dosage and frequency of platinum-based chemoradiotherapy (CRT) regimen for treating advanced head and neck squamous cell carcinoma remains unresolved. This study aims to compare the toxicity and efficacy of weekly versus more dose-intensive cisplatin-based CRTs. Methods We reviewed 155 stage III/IV head and neck squamous cell carcinoma patients with no evidence of distant metastasis treated with one of two CRT regimens from 2000 to 2010 at Greater Baltimore Medical Center. Twice-daily radiation was provided as a split course over a 45-day period. Regimen A consisted of concomitant cisplatin (30?mg/m2/1?h) weekly for 6 cycles; regimen B consisted of concomitant cisplatin (12?mg/m2/1?h) and 5-fluorouracil (600?mg/m2/20?h) on days 1 through 5 and days 29 through 33. Main outcome measures included acute toxicities (myelosuppression, neurotoxicity, nephrotoxicity, gastrointestinal dysfunction), unplanned hospitalizations, and disease control at 12?months. Results Patients on regimen A were much less likely to experience ototoxicity due to their treatment (0% vs. 9.8%, P?=?0.04). They were more likely to experience thrombocytopenia acutely (46% vs. 26%, P?=?0.02), but the toxicity was not limiting (grade 1-). No significant differences exist in the incidence of other toxicities or unplanned hospitalizations. At 1?year, 97% of patients on A vs. 86% of patients on regimen B were free of disease (P?=?0.11). Conclusions With concurrent radiotherapy, low-dose, single-agent, weekly cisplatin is less likely than higher-dose daily cisplatin plus 5-fluorouracil provided at the beginning and end of treatment to be associated with ototoxicity. The preliminary data suggest at least equivalent efficacy, but longer follow-up is required.