Standard approach for treatment of locally advanced head and neck carcinoma is concurrent chemoradiation with cisplatin 100mg/m2 every three week. However, prescribing cisplatin at this dose is associated with increased toxicity that can interrupt and compromise treatment results. Many centers use alternative schedules of weekly cisplatin at doses of 30-40 mg/m2 per week.
In this study, 77 patients with head and neck cancer were randomized in a phase II clinical trial to compare toxicity for two cisplatin schedules, 100mg/m2 three weekly and 40mg/m2 weekly.
The incidence of grade 3-4 hematologic events was not significantly different between the two groups, but the mean level of glomerular filtration rate in the three weekly group was significantly higher than the weekly group. There was no significant difference between the two groups in terms of mean overall treatment time and mean dose of cisplatin. Cisplatin cumulative dose ≥ 200mg/m2 was higher in the weekly group, but no significant difference was observed. The main reason for treatment interruption was neutropenia for the three-weekly group, but in the weekly group, it was renal dysfunction for chemotherapy delay, and thrombocytopenia for radiotherapy break.
Weekly prescribing cisplatin can lead to higher cumulative doses, which may improve treatment outcomes. The incidence of grade 3-4 hematologic events was not significantly different between the two groups; However, the weekly schedule was associated with a higher drop in GFR, requiring further investigation.
Clinical trial identification
Legal entity responsible for the study
Shahid Beheshti University of Medical Science.
Research and Development Center of Shahid Beheshti University of Medical Science.
All authors have declared no conflicts of interest.