A comparative study of weekly versus three-weekly cisplatin concurrently with 3- dimensional conformal radiotherapy in locally advanced head and neck cancer

Introduction: Cisplatin based concurrent chemoradiotherapy (CCRT) is the standard treatment for locally advanced head and neck squamous cell cancer (LAHNSCC) (stage III–IV), in a definitive radical upfront setting or after surgical resection in high-risk patients.Despite the routine use of 100 mg/m2 cisplatin 3-weekly, the optimal dose and timing of cisplatin administration in various chemotherapy protocols have not been elucidated and available data is insufficient to suggest which chemotherapy schedule is superior in terms of better disease control.
Aim: To evaluate the efficacy and toxicity of weekly verses three weekly cisplatin given concurrently with radiotherapy in patients with LAHNSCC.
Materials and Methods: It was aprospectively randomized, two- arm comparative study included 110 LAHNSCC patients, which was randomized into two arms: Study arm (n=55) patients received cisplatin 30 mg/m2 weekly for 6 weeks along with radiation; Control arm (n=55) patients received cisplatin three weekly 80 mg/m2 on day 1, 22 and43 of radiation. Radiotherapy was delivered to a total dose of 70 Gy by 3-dimensional conformal technique at linear accelerator. Tumor response and toxicities were evaluated by the help of Response Evaluation Criteria in Solid Tumours (RECIST) (version 1.1) criteria and Radiation Therapy Oncology Group (RTOG) Acute Radiation Morbidity Criteria respectively.
Results: complete response (CR) was achieved in 36 patients (65.5%) in the Study group and 35 patients (63.6%) in the Control group. The partial response (PR) rates were 15 patients (27.3%) in Study group and 13 patients (23.6%) in Control group. Mainly observed toxicities were mucositis, dermatitis, Nausea & vomiting, neutropenia, thrombocytopenia and nephrotoxicity. All observed toxicities were more in control group but the difference was statistically significant only for mucositis and nausea & vomiting
Conclusion: Weekly cisplatin is a well-tolerated schedule with concurrent radiotherapy without potentiating toxicities and having almost similar efficacy as that of three-weekly schedule.