Download PDF
CC BY-NC-ND 4.0 · South Asian J Cancer 2019; 08(03): 178-182
DOI: 10.4103/sajc.sajc_270_18
ORIGINAL ARTICLE: Head and Neck Cancers

A prospective randomized study comparing concurrent chemoradiation with weekly and 3 weekly cisplatin in locally advanced oropharyngeal carcinoma

R. Nanda
Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka
,
Aradhana Katke
Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka
,
N. Suneetha
Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka
,
B. Thejaswini
Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka
,
Tanvir Pasha
Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka
,
K. P. Jagannath
Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka
,
G. V. Giri
Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka
,
Govind K. Babu
Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka
› Author Affiliations Financial support and sponsorship Nil.
› Further Information
Also available at
  PDF Download Permissions and Reprints

Abstract

Introduction: The chemotherapy schedules with cytotoxic dose or weekly regimes are still challenging, weighing the benefits versus toxicities. This prospective randomized study is an attempt to assess the efficacy of two schedules of cisplatin in management of locally advanced HNSCC. Objectives: The objectives of this study was to evaluate tolerance, tumour response and toxicities of concurrent chemoradiation with cisplatin in weekly and three weekly regimes. Methods: Locally advanced oropharyngeal squamous cell carcinoma patients fit for concurrent chemoradiation with cisplatin 40 mg/m2 (weekly) and 100 mg/m2 (3 weekly) were randomized to Arm A and B concurrently with radiotherapy of 70Gy/35frs/7 weeks. Statistical Analysis: Chi-square/Fisher Exact test has been used to find the significance of study parameters on categorical scale between the groups. The statistical software SPSS 15.0 was used. Results: Between December 2010 and January 2013, 60 patients were enrolled. The median cycles of cisplatin in Arm-A was 5 and 2 in Arm-B. The complete response of 80.9% vs 75% and partial response of 14.3% vs 12.5% was observed in both arms respectively. There was no statistical difference in acute radiation and hematological toxicities between the two groups. With median follow up of 28 months, the 2 and 5 years overall survival was 55% and 58%; 41.6% and 32.3% in arms A and B respectively. Conclusion: In our study of locally advanced oropharyngeal carcinoma treated with radical radiotherapy comparing concurrent chemotherapy with cisplatin weekly vs 3 weekly had no significant difference in overall response, complete response and acute toxicities.

Key words

Advanced oropharyngeal carcinoma - concurrent chemoradiation - survival - 3 weekly and weekly cisplatin - toxicities


Publication History

Article published online:
21 December 2020

© 2019. MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global Cancer Statistics. CA Cancer J Clin 2011;61:69-90.
  • 2 Ries LAG, Melbert D, Krapcho M, Mariotto A, Miller BA, Feuer EJ, et al., Eds. SEER Cancer Statistics Review, 1975–2004. Bethesda, MD: National Cancer Institute; 2007. Available from: http://seer.cancer.gov/csr/1975_2004/. [Last accessed on 2017 Jul].
  • 3 Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimation of worldwide burden of cancer in 2008. Globocan 2008 Int J Cancer 2010;127:2893-917.
  • 4 Sharma A, Mohanti BK, Thakar A, Bahadur S, Bhasker S. Concomitant chemoradiation versus radical radiotherapy in advanced squamous cell carcinoma of oropharynx and nasopharynx using weekly cisplatin: A phase II randomized trial. Ann Oncol 2010;21:2272-7.
  • 5 Forastiere AA, Goepfert H, Maor M, Pajak TF, Nader R, Morrison W, et al. Concurrent radiotherapy and chemotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 2003;349:2091-8.
  • 6 Pignon JP, Bourhis J, Domenge C, Designe L. Chemotherapy added to locoregional treatment for HNSCC: Three meta analyses of updated individual data. The Lancet 2000;355:949-55.
  • 7 Pignon JP, Maitre AL, Bourhis J. Meta analysis of chemotherapy in head and neck cancer (MACH-NC): An update. Int J Radiat Oncol Biol Phys 2007; 69:s112-4.
  • 8 Pignon JP, Maitre AL, Maillard E, Bourhis J. Meta analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 93 randomised trials and 17,346 patients. Radiother Oncol 2009;92:4-14.
  • 9 Ang KK. Concurrent radiation chemotherapy for locally advanced head and neck cancer: Are we addressing burning subjects? J Clin Oncol 2004; 22:4657-9.
  • 10 Glickman AS, Slotman G, Doolittle C, Clark J, Koness J, Coachman N, et al. Concurrent cis-platinum and radiation with or without surgery for advanced head and neck cancer. Int J Radiat Oncol Biol Phys 1994;30:1043-50.
  • 11 Crissman JD, Pajak TF, Zarbo RJ, Marcial VA, AI-Sarraf M. Improved response and survival to combined cis-platin and radiation in nonkeratinizing squamous cell carcinomas of the head and neck. An RTOG study of 114 advanced stage tumors. Cancer 1987;59:1391-7.
  • 12 Marcial VA, Pajak TF, Mohiuddin M, Cooper JS, al Sarraf M, Mowry PA, et al. Concommitant cisplatin CT and RT in advanced mucosal squamous cell carcinoma of the head and neck. Long-term results of the Radiation Therapy Oncology Group study 81-17. Cancer 1990;66:1861-8.
  • 13 Koch WM, Lee DJ, Eisele DW, Miller D, Poole M, Cummings CW, et al. ChemoRT for organ preservation in oral and pharyngeal carcinoma. Arch Otolaryngol Head Neck Surg 1995;121:974-80.
  • 14 Byfield JE, Sharp TR, Frankel SS, Tang SG, Callipari FB. Phase I and II trial of five-day infused 5-fluorouracil and radiation in advanced cancer of the head and neck. J Clin Oncol 1984;2:406-13.
  • 15 Browman GP, Cripps C, Hodson DI, Eapen L, Sathya J, Levine MN. Placebo-controlled randomized trial of infusional flurouracil during standard RT in locally advanced head and neck cancer. J Clin Oncol 1994;12:2648-53.
  • 16 Gupta NK, Pointon RC, Wilkinson PM. A randomized clinical trial to contrast RT and RT and methotrexate given synchronously in head and neck cancer. Clinical Radiology 1987;38:575-81.
  • 17 Haffty BG, Son YH, Papc R. Chemotherapy as an adjunct to radiation therapy in the treatment of squamous cell carcinoma of the head and neck: Results of the yale mitomycin C randomized trials. J Clin Oncol 1997;15:268-76.
  • 18 Adelstein DJ, Yi Li, Adems GL, Wagner H, Kish JA. An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol 2003;21:92-8.
  • 19 Brizel DM, Esclamado R. Concurrent chemotherapy for locally advanced non metastatic SCCHN: Consensus, Controversy and Concundrum. J Clin Oncol 2006;24:2612-7.
  • 20 Salama JK, Seiwert TY, Vokes EE. Chemoradiotherapy for locally advanced head and neck cancer. J Clin Oncol 2007;25:4118-26.
  • 21 Geetha SN, Padmanabhan TK, Samuel J, Pavithran K, Iyer S, Kuriakose MA. Comparison of acute toxicities of two chemotherapy schedules for head and neck cancers. J Cancer Res Ther 2006;2:100-4.
  • 22 Uygun K, Bilici A, Karagol H, Caloglu M, Cicin I, Aksu G, et al. The comparison of weekly and three-weekly cisplatin chemotherapy concurrent with radiotherapy in patients with previously untreated inoperable non-metastatic squamous cell carcinoma of the head and neck. Cancer Chemother Pharmacol 2009;64:601-05.
  • 23 Mitra D, Choudhury K, Rashid MA. Concurrent chemotherapy in advanced head and neck carcinoma- A prospective randomized trial. Bangaladesh J Otorhinolaryngol 2011;17:88-95.
  • 24 Fayette J, Molin Y, lavergne E, Montbarbon X, Sacadot S, Poupart M, et al. Radiotherapy potentiation with weekly cisplatin compared to standard every 3 weeks cisplatin chemotherapy for locoregionally advanced head and neck squamous cell carcinoma Drug Design, Development and Therapy. 2015;9:6203-10.
  • 25 Gupta T, Agarwal JP, Ghosh-Laskar S, Parikh PM, D'Cruz AK, Dinshaw KA. Radical radiotherapy with concurrent weekly cisplatin in loco-regionally advanced SCCHN: A single institution experience. Head and Neck Oncology 2009;1:17-28.
  • 26 Ho KF, Swindell R, Brammer CV. Dose intensity comparison between weekly and 3-weekly Cisplatin delivered concurrently with radical radiotherapy for head and neck cancer: A retrospective comparison from New Cross Hospital, Wolverhamton, UK. Acta Oncol 2008;47:513-8.
  • 27 Marcu L, van Doorn T, Olver I. Cisplatin and radiotherapy in the treatment of locally advanced head and neck cancer--a review of their cooperation. Acta Oncol 2003;42:315-25.
  • 28 Harari PM, Mehta MP, Ritter MA, Petereit DG. Clinical promise tempered by reality in the delivery of combined chemoradiation for common solid tumors. Seminars in Radiation Oncology 2003;13;3-12.
  • 29 D'cruz A, Lin T, Anand AK, Atmakusuma D, Calaguas MJ, Chitapanarux I, et al. Consensus recommendations for management of head and neck cancer in Asian countries: A review of international guidelines. Oral Oncology 2016;53;10-6.
  • 30 Bourhis J, Lapeyre M, Tortochaux J, Rives M, Aghili M, Bourdin S, et al. Phase 3 randomised trial of very accelerated radiotherapy compared with conventional radiotherapy in SCCHN; A GORTEC trial; J Clin Oncol 2006;24:2873-8.
  • 31 Bourhis J, Overgaard J, Audry H, Ang KK, Saunders M, Bernier J, et al. Hyperfractionated or accelerated radiotherapy in head and neck carcinoma; A meta analysis. Lancet 2006;368:843-54.
  • 32 Overgaard J, Hansen HS, Specht L, Overgaard M, Grau C, Andersen E, et al. Five compared six fraction per week of conventional radiotherapy of HNSCC: DHANCA 6&7 randomised controlled trial. Lancet 2003; 362:933-40.
  • 33 Lasker SG, Agarwal JP, Srinivas C, Dinshaw KA. Radiotherapeutic management of locally advanced Head & Neck cancer. Expert Rev Anticancer Ther 2006;6:405-17.
  • 34 Homma A, Inamura N, Oridate N, Suzuki S, Hatakeyama H, Mizumachi T, et al. Concomitant weekly cisplatin and radiotherapy for head and neck cancer. Jpn J Clin Oncol 2011;41:980-6.
  • 35 Geiger JL, Lazim AF, Walsh FJ, Foote RL, Moore EJ, Okuno SH, et al. Adjuvant chemoradiation therapy with high-dose versus weekly cisplatin for resected, locally-advanced HPV/p16-positive and negative head and neck squamous cell carcinoma. Oral Oncology 2014;50;311-8.