A comparative study between cisplatin weekly versus every 3 weeks concurrently with radiotherapy in the locally advanced head and neck squamous cell carcinomas

Abstract

Author(s): Walid A. Almorsy and Neseen M.Sabry*

Background and objectives: Head and neck cancers are vigorous types of cancers and they are considered among the fifth commonest cancer types globally. Among these, squamous cell carcinoma is the commonest. Although advanced treatment in head and neck cancers have been detected, insignificant and unclear improvements in patient survival were revealed. Cisplatin along with radiotherapy is used to increase the sensitivity of radiation in those patients. However, the complete patient’s benefit from cisplatin-based radio-sensitization is unclear which reflects shortage of biomarkers predicting sensitivity. Thus, this study aimed at comparing high and low dose of cisplatin treatment concomitantly administered with radiation therapy regarding safety and efficacy in patients with locally advanced head and neck squamous cell carcinoma.

Materials and methods: Forty-six patients with locally advanced HNSCC (stages 3 and 4) were included. Patients have gone thorough pre-treatment clinical evaluation such as full medical history and physical examination, CT, PET/CT and MRI. The patients have equally divided into two groups. In group A, the planned protocol was 100 mg/m² every 3 weeks (on days 1, 22, and 43), respectively whereas in group B, cisplatin was administrated concomitantly with radiotherapy at a planned dose of 30 mg/m² weekly.

Results: Although no significant difference was detected regarding treatment response between our studied groups, insignificant improvement in survival was detected in higher cisplatin dose in comparison with lower doses. In addition, mucositis and dysphagia were significantly higher in high-dose Cisplatin group compared to low-dose cisplatin group with no significant difference detected in other side effects.

Conclusion: High dose cisplatin concomitantly used with radiotherapy showed higher but insignificant survival in comparison with low dose cisplatin with better toxicity profile in favour of low dose protocol. We recommend future large-scale studies with multiple low dose regimens for the evaluation of benefit/hazard balance of low dose versus high dose cisplatin with concurrent radiotherapy in treating HNSCC patients.

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