Dose intensity comparison between weekly and 3-weekly Cisplatin delivered concurrently with radical radiotherapy for head and neck cancer: A retrospective comparison from New Cross Hospital, Wolverhampton, UK

Abstract

Aims. In this retrospective comparison, we describe the differences in dose intensity, delays and toxicity between weekly Cisplatin and 3-weekly Cisplatin given concurrently to patients with locally advanced squamous head and neck cancer (SCCHN) at New Cross Hospital, Wolverhampton. Materials and methods. Fifty-one patients received radical Cisplatin based chemoradiotherapy for stage 4a SCCHN of the head and neck between September 2000 and December 2004. Twenty-seven patients were treated with 3-weekly inpatient Cisplatin for 3 cycles (20 patients-80 mg/m²; 7 patients-100 mg/m²) concomitantly with radiotherapy (66–70 Gy/33–35 fractions). Twenty-four patients received a similar radiotherapy schedule but received weekly Cisplatin 33–40 mg/m². Results. More patients received a higher cumulative dose of at least 240 mg/m² if given weekly Cisplatin 40 mg/m² or 3-weekly Cisplatin 80 mg/m² compared with those receiving Cisplatin 3-weekly 100 mg/m² (p=0.04). Maximum cumulative dose achievable in the latter group was only 200 mg/m² and none achieved the full 3 cycles. Mean Cisplatin dose in the weekly Cisplatin 40 mg/m² regime (mean 202 mg/m²) and 3-weekly arm of 80 mg/m² (mean 203 mg/m²) was higher than that reached if given 3-weekly Cisplatin 100 mg/m² (mean 180 mg/m²) although statistically insignificant (p=0.39) due to the small number of patients. More delays (29% vs. 41%) and omission of chemotherapy (5.6% vs. 17.4%) occurred in the 3-weekly compared with the weekly regime. Toxicity, radiotherapy overall treatment time and delays were similar between the two groups. Conclusion. Delivery of 100 mg/m² Cisplatin 3-weekly with radiotherapy was less tolerated than 40 mg/m² weekly and resulted in less patients achieving cumulative dose beyond 200 mg/m², potentially lowering chemotherapy dose intensity.