989P - Ototoxicity in locally advanced head and neck cancer (LAHNC) patients (pts) treated with induction chemotherapy (IC) followed by cisplatin-based ch...

Date 09 October 2016
Event ESMO 2016 Congress
Session Poster display
Topics Head and Neck Cancers
Surgical oncology
Therapy
Radiation oncology
Presenter Chantal Driessen
Citation Annals of Oncology (2016) 27 (6): 328-350. 10.1093/annonc/mdw376
Authors C. Driessen1, A. Snik2, J. Leijendeckers2, J.P. de Boer3, H. Gelderblom4, C. van Opstal1, W. van der Graaf1, J. Kaanders5, C. van Herpen1
  • 1Department Of Medical Oncology/452, Radboud University Medical Centre Nijmegen, 6500 HB - Nijmegen/NL
  • 2Ear, Nose And Thraot Department, Radboud University Medical Centre Nijmegen, 6500 HB - Nijmegen/NL
  • 3Medical Oncology, Het Nederlands Kanker Instituut Antoni van Leeuwenhoek (NKI-AVL), 1006 BE - Amsterdam/NL
  • 4Clinical Oncology, Leiden University Medical Center (LUMC), 2300 - Leiden/NL
  • 5Radiation Oncology, Radboud University Medical Centre Nijmegen, 6500 HB - Nijmegen/NL

Abstract

Background

The CONDOR study, a randomized phase II study, investigated feasibility of docetaxel/cisplatin/5-fluorouracil (TPF) followed by conventional radiotherapy with cisplatin 100 mg/m2 on days 1, 22, 43 (cis100 + RT) versus accelerated radiotherapy with cisplatin weekly 40 mg/m2(cis40 + ART) in LAHNC pts. The effect of the two regimens on ototoxicity was investigated.

Methods

Audiometry was carried out at baseline, during and after TPF before start of CRT, and 1, 4, 8 and 12 months after end of treatment. Air-conduction thresholds were determined in octave steps from 1 kHz until 8 kHz. Where 1 to 4 kHz is relevant for speech. Based on baseline thresholds we divided the pts in two groups; pts with baseline thresholds  50 dB.

Results

62 pts started with TPF; 56 pts were randomized to cis100 + RT (n = 27) or cis40 + ART (n = 29). Compliance to audiometry was low, mostly due to poor physical condition. Pts included in this analysis were 12 in cis100 + RT and 11 in cis40 + ART. Mean cumulative cisplatin dose was 498 mg/m2 (SD 66.1) for cis100 + RT and 490 mg/m2 (SD 55.8) for cis40 + ART (p = 0.75). Hearing deterioration over time was gradually for cis40 + ART and abrupt for cis100 + RT; with a wide spread in both groups. Mostly, the abrupt hearing deterioration occurred during CRT. Hearing loss was most prominent at 8 kHz and almost absent at 2 kHz. We used the Wilcoxon test for our hypothesis that pts treated with cis100 + RT suffer more hearing loss than pts treated with cis40 + ART; showing a difference for 8 kHz (z = 2.07; p = 0.03) and 4 kHz (z = 1.98, p = 0.04). Analysis for hearing deterioration in the subgroup of baseline hearing  50 dB mean deterioration was less, approximately 10 dB. In 15 pts we could compare data from 12 versus 4 months after end of treatment. These showed no clinically relevant at 8 kHz.

Frequency Cis100 + RT Cis40 + ART
8 kHz 41 dB 20 dB
4 kHz 30 dB 12 dB
2 kHz 7 dB 3 dB

Conclusions

After TPF CRT with cis40 + ART is less ototoxic than CRT with cis100 + RT.

Clinical trial identification

NCT00774319

Legal entity responsible for the study

Carla van Herpen

Funding

Sanovi Aventis Netherlands Dutch Cancer Society

Disclosure

All authors have declared no conflicts of interest.