Assessment of Swallowing Function in Patients with Head and Neck Squamous Cell Carcinoma in High vs. Low Dose Cisplatin

Abstract

Background: Head and neck squamous cell carcinoma (HNSCC) is the most common cancer of its anatomical region. Cisplatin-based therapies are the gold standard of treatment for both HPV- associated and non-HPV-associated etiologies. The treatment regimen includes either 3 weeks of high-dose cisplatin or 6 weeks of low-dose cisplatin, both with concurrent radiation. Malnutrition, secondary to decreased swallowing function, poses a significant challenge to HNSCC treatment. Swallowing function is a significant marker for prognosis and outcome of patients being treated for HNSCC, but the effects of cisplatin dosage on swallowing function have not been studied. The present study sought to understand how each cisplatin regimen affected swallowing function. Methods: A cohort of 237 patients who were treated for HNSCC at the University of South Dakota Sanford Medical Center in Sioux Falls, SD, between 2010 and 2019 were studied via retrospective electronic medical record review; 109 received high-dose and 128 received low- dose cisplatin. Gastrostomy tube dependence at various timepoints was used as the primary endpoint given that it serves as a proxy for swallowing function. Secondary endpoints included weight changes, esophageal stricture, lymphedema, hospital admission, and overall survival. Descriptive statistics were used to summarize demographics and treatment variables. Bivariate associations between independent and dependent variables were analyzed. Chi-square tests were used for categorical variables and t-tests for continuous variables. Statistical tests were two-tailed and the significance level set at p <0.05. Results: Both the primary and secondary outcomes were not statistically significant. Ototoxicity and renal toxicity were significantly higher in the high-dose group. Ototoxity overall was significantly higher (p=0.0005), with audiology testing and referral for hearing aids both being significantly higher (p<0.001 and 0.0003, respectively). Renal toxicity was significantly higher at the 30-day and 1-year post-treatment timepoints (p=0.0005 and p=0.02, respectively). Conclusion: This study suggests that swallowing function is not different in patients receiving high vs. low dose cisplatin for HNSCC treatment. Although the significant data on ototoxicty and nephrotoxicity supports already established conclusions regarding the toxicity of high-dose cisplatin, it strengthens our lack of statistical significance in the primary and secondary endpoints.