Comparing two lower-dose cisplatin programs for radio-chemotherapy of locally advanced head-and-neck cancers
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- 作者：Dirk Rades ; Daniel Seidl ; Stefan Janssen…
- 关键词：LA ; SCCHN ; Radio ; chemotherapy ; Lower ; dose cisplatin ; Loco ; regional control ; Survival ; Toxicity
- 刊名：European Archives of Oto-Rhino-Laryngology
- 出版年：2017
- 出版时间：February 2017
- 年：2017
- 卷：274
- 期：2
- 页码：1021-1027
- 全文大小：
- 刊物类别：Medicine
- 刊物主题：Otorhinolaryngology; Neurosurgery; Head and Neck Surgery;
- 出版者：Springer Berlin Heidelberg
- ISSN：1434-4726
- 卷排序：274
文摘
Radio-chemotherapy is a common treatment for locally advanced squamous cell head-and-neck cancers (LA-SCCHN). Cisplatin (100 mg/m2) every 3 weeks is very common but associated with considerable toxicity. Therefore, cisplatin programs with lower daily doses were introduced. There is a lack of studies comparing lower-dose programs. In this study, 85 patients receiving radio-chemotherapy with 20 mg/m2 cisplatin on 5 days every 4 weeks (group A) were retrospectively compared to 85 patients receiving radio-chemotherapy with 30–40 mg/m2 cisplatin weekly (group B). Groups were matched for nine factors including age, gender, performance score, tumor site, T-/N-category, surgery, hemoglobin before radio-chemotherapy, and radiation technique. One- and 3-year loco-regional control rates were 83 and 69 % in group A versus 74 and 63 % in group B (p = 0.12). One- and 3-year survival rates were 93 % and 73 % in group A versus 91 and 49 % in group B (p = 0.011). On multivariate analysis, survival was significantly better for group A (HR 1.17; p = 0.002). In groups A and B, 12 and 28 % of patients, respectively, did not receive a cumulative cisplatin dose ≥180 mg/m2 (p = 0.016). Toxicity rates were not significantly different. On subgroup analyses, group A patients had better loco-regional control (p = 0.040) and survival (p = 0.005) than group B patients after definitive radio-chemotherapy. In patients receiving adjuvant radio-chemotherapy, outcomes were not significantly different. Thus, 20 mg/m2 cisplatin on 5 days every 4 weeks resulted in better loco-regional control and survival in patients receiving definitive radio-chemotherapy and may be preferable for these patients. Confirmation of these results in a randomized trial is warranted.