Concurrent chemoradiotherapy with cisplatin is standard for patients (pts) with loco-regionally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). The standard regimen includes 3-weekly cisplatin, but weekly regimens are often used to lower toxicity. Reaching a cumulative dose of > 200 mg/m2 cisplatin was shown being associated with improved outcome. We herein investigated cumulative dose reached and toxicity between the both widely used 3-weekly and weekly cisplatin regimens with concurrent radiotherapy.
Multicentre, retrospective analysis of all patients with LA-SCCHN treated at 3 centers in Switzerland between 06/2008 and 12/2015. We used descriptive statistics and logistic regression (uni- and multivariable) to investigate the association between the chosen cisplatin regimen (weekly versus 3-weekly) and the chance to reach the cumulative cisplatin dose of > 200 mg/m2. Landmark approach (8 weeks after start of treatment) was applied for investigating the prognostic impact of the cumulative cisplatin dose on survival using Cox regression techniques.
We included 314 eligible pts (3-weekly schedule, N = 127; weekly schedule, N = 187). Median cumulative cisplatin dose was 200 mg/m2 (IQR 150-300) for pts treated with a 3-weekly schedule and 160 mg/m2 (120-240) for the weekly schedule, consequently more pts treated with a 3-weekly schedule reached a cumulative dose >200 mg/m2 (75.6% vs. 47.1%, p 200 mg/m2 is associated with better survival (HR 1.3, 95% CI 0.8 -1.9).
Significantly more patients receive a cumulative of dose of > 200 mg/m2, when treated with a 3-weekly schedule compared to weekly dosing. This comes at the cost of more renal toxicity. Due to the non-randomized nature of this analysis, no conclusions on the efficacy of the respective schedules should be drawn.
Clinical trial identification
Legal entity responsible for the study
University Hospital Basel
All authors have declared no conflicts of interest.