Conventional Radiotherapy with Concurrent Weekly Cisplatin in Locally Advanced Head and Neck Cancers of Squamous Cell Origin - a Single Institution Experience

Abstract

<b>Background:</b> Platinum based concurrent chemo-radiation is the de-facto standard of care in the non-surgicalmanagement of locally-advanced head and neck cancer of squamous origin. Three-weekly single agent cisplatinat 100 mg/m2 concurrent with radical radiotherapy has demonstrated consistent improvement in loco-regionalcontrol and survival. This improvement is however at the cost of considerable hematologic toxicity and pooroverall compliance. The routine use of this regime is improbable in developing countries with limited resources. Wetherefore aimed to determine the safety and efficacy of an alternative regime of weekly cisplatin and concurrentradiotherapy in such patients. Materials and <br/><b>Methods</b>: January-05 and April-12, 188 patients of locally-advancedhead and neck cancer of squamous origin were treated with concurrent weekly-cisplatin at 35mg/m2 andconventional radiotherapy 60-66Gy/30-33 fractions/5days per week. <br/><b>Results</b>: Overall, 95% patients receivedplanned doses of RT while 74% completed within the stipulated overall treatment time of <50 days. Eighty-twopercent received at-least 5 weekly cycles. Grade-III/IV mucositis was seen in 58%/9% respectively, which resultedin mean weight loss of 9.2% from a pre-treatment mean of 54.5 kg. Grade-III hematologic toxicity-0.5%; gradeII nephrotoxicity-2.5% and grade III emesis-3% were also seen. Grade-III/IV subcutaneous toxicity-10%/1%and grade-III/IV xerostomia-10%/0% were observed. Complete responses at the primary site, regional nodesand overall disease were seen in 86%, 89% and 83% patients respectively. The median and 5-years disease-freesurvival were 26 months and 39.4% respectively, while the median and overall survival were 27 months and41.8% respectively. <br/><b>Conclusions</b>: Weekly-cisplatin at 35 mg /m2 when delivered concurrently with conventionalradical RT (at-least 66y/33 fractions) in locally-advanced head and neck cancer is well tolerated with minimalhematologic and neprologic toxicity and can be routinely delivered on an out-patient basis. It is an effectivealternative to the standard 3-weekly cisplatin especially in the context of developing countries.