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ORIGINAL ARTICLE
Year : 2020  |  Volume : 7  |  Issue : 1  |  Page : 17-24

Modified 3-weekly cisplatin or cisplatin-5-fluorouracil 5-day infusion as the concurrent chemoradiotherapy regimen in locally advanced squamous cell carcinoma of the head and neck: Comparison of efficacy and toxicity


1 Division of Medical Oncology and Hematology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
2 Department of Otorhinolaryngology, MacKay Memorial Hospital, Taipei, Taiwan
3 Department of Oral and Maxillofacial Surgery, MacKay Memorial Hospital, Taipei, Taiwan
4 Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan
5 Division of Medical Oncology and Hematology, Department of Internal Medicine; Department of Medical Research, Good Clinical Research Center, MacKay Memorial Hospital, Taipei, Taiwan

Correspondence Address:
Dr. Yi-Fang Chang
Division of Medical Oncology and Hematology, Department of Internal Medicine, MacKay Memorial Hospital, No. 92, Section 2, Zhongshan N Road, Zhongshan District, Taipei 90104
Taiwan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JCRP.JCRP_27_19

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Background: Concurrent chemoradiotherapy (CCRT) is an important therapeutic strategy in locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). We evaluated the efficacy and toxicity of two CCRT regimens in treating LA-SCCHN. Materials and Methods: LA-SCCHN patients receiving CCRT with either a modified 3-weekly cisplatin 75 mg/m2 (Group A, n = 86) or 5-day continuous infusion of cisplatin 12 mg/m2 plus 5-fluorouracil (5-FU) 600 mg/m2 (Group B, n = 87) were enrolled. The Kaplan−Meier method was used to estimate overall survival (OS), progression-free survival (PFS), and locoregional recurrence-free survival (LRFS). Univariate and multivariate analyses were performed using Cox proportional hazard models to assess correlations between clinical parameters and survival. Results: With a median of 35.8 months' follow-up, the median OS and PFS in Group A and Group B were 65.9 versus 55.0 months (P = 0.546) and 34.6 versus 33.3 months (P = 0.948), respectively. LRFS was not reached in either group. Group B patients had more Grade 3−4 mucositis (53.7% vs. 32.28%, P= 0.001) and dermatitis (49.8% vs. 21.5%, P= 0.0001). Trends of higher incidence rates of Grade 3−4 hematologic and renal toxicity were observed in Group A. After statistical adjustment, higher disease stage (Stage IVb) (hazard ratio [HR] = 6.657, 95% confidence interval [CI] 1.786−24.81, P= 0.005) and pretreatment anemia (hemoglobin <13 g/dL) (HR = 1.896, 95% CI 1.063−3.391, P= 0.030) were associated with poor OS. Conclusion: A 5-day cisplatin-5-FU regimen was associated with more frequent Grade 3−4 mucositis and dermatitis than a 3-weekly cisplatin regimen. A multiagent CCRT regimen did not provide survival benefits but increased adverse events.


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