Abstract 693P
Background
Three-weekly high-dose cisplatin (100 mg/m2) is considered the standard systemic regimen given concurrently with postoperative or definitive radiotherapy in locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). Concurrent chemoradiation (CRT) with high-dose cisplatin is associated with 30% of acute kidney injury (AKI). The aims of this study were to investigate the impact of our outpatient protocol of 7 day hydration after each cisplatin administration on the tolerance.
Methods
We collected data from patients with LA-SCCHN treated with 3-weekly cisplatin CRT in the Department of Radiotherapy at Gustave Roussy between January 2015 and December 2017. Our institutional protocol for 3-weekly cisplatin comprises a three day in-hospital stay during which the patient receives BIONOLYTE G5 1L perfusion over 3h x3 followed by cisplatin perfusion over 3h and BIONOLYTE G5 1L perfusion over 3h x2. After each cycle of cisplatin, patients received 1L of saline perfusion 0.9% over 12h every night for one week as outpatients.
Results
250 eligible patients were analyzed; 200 (80%), were male, 247 (98.8%) aged < 70 years, 50 (20%) had hypertension and 7 (2.8%) diabetes. 223 patients (89.2%) were tobacco smokers and 118 (47.2%) had a current use of alcohol. Before CRT, 50 (20%) patients had already received induction chemotherapy with TPF and 70 (28%) had undergone surgery. 220 patients (88%) received ≥ 200 mg/sqm and 107 (42.8%) completed dose of 300 mg/sqm. Mean cumulative dose of cisplatin during CRT was of 236 mg/sqm. 29 patients (14.5%) had acute kidney injury; 7 patients had grade I (3.5%), 8 grade II (4%) and 14 grade III (7%). No grade 4 or 5 toxicities were reported. 26 patients required CDDP dose reduction/delays because of nephrotoxicity.
Conclusions
The proportion of patients developing AKI following high dose of cisplatin in our study is lower than the expected range of AKI among patients that did not undergo one-week hydration post-cisplatin and the proportion of patients receiving more than 200 mg/sqm as a total dose during CRT is extremely high in our daily practice. This strategy is a very efficacious method to diminish the AKI and give more dose of cisplatin.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
E. Deutsch: Other, Personal and Institutional, Advisory Board: Merck Serono, AstraZeneca; Financial Interests, Personal, Invited Speaker, Research Funding: Roche; Financial Interests, Institutional, Research Grant: Boehringer Ingelheim. All other authors have declared no conflicts of interest.