Concomitant chemoradiation using weekly cisplatin for advanced squamous cell carcinoma of head and neck: Experience from a tertiary cancer center in India.

Abstract

5548 Background: CTRT is preferred non-surgical treatment for advanced SCCHN. Weekly or 3 weekly cisplatin (DDP) as a single agent is commonly used. Methods: Between 2001-2009, 713 pts of SCCHN (mostly stage III or IV) pts with PS<2 were treated with CTRT using - DDP 40 mg/m2 weekly for 6-7 weeks concomitantly with standard schedule of RT (70Gy/35# over 7 weeks) at AIIMS, New Delhi. Analysis of 691 pts whose records have been traced is reported here. We also tried to identify prognostic factors for survival. Results: Number of pts 713 (evaluated 691), Males- 640, Median age 51 (range 12-77; 160 were> 60 yrs). Primary site of disease: nasopharynx 105, oropharynx 358, hypopharynx 96, larynx 127, and others 24. 247 had stage III, 262 had stage IVA, and 45 had stage IVB disease. Baseline serum albumin was < 3.5gm/dl in 55 patients and >3.5 gm/dl in 568 pts. 497 pts completed > 5 weeks of DDP, and 566 received > 60 Gys of RT. Responses: CR in 435 (62%), PR in 112 (15.8%). Toxicity- 274 (39%) pts had grade III/IV (mucositis-215, myelosuppression- 24, vomiting-35). 8 died of toxicity. 152 required hospitalization (for various reasons) and 187 had treatment interrupted for variable period. Survival- Five years OS of whole group is 62% (median NR). Mean OS as per primary site is; nasopharyngeal 72 months, oropharyngeal 74 months, hypophayngeal 36 months (median), and laryngeal 83 months. OS for non-hypopharyngeal primary was superior to hypopharyngeal primary (p=0.008). Patients with low albumin had poor OS (median 19 months) vs NR in patients with > normal albumin (p=0<00001). Patients with stage <III had superior OS compared to stage IV (77 vs 73 months; p=0.02). In univariate analysis low albumin, hypopharyngeal primary, and stage IV disease were identified as poor prognostic factors. In multivariate analysis low albumin emerged as poor prognostic factor (HR=3.06; p=<0.0001). Conclusions: Weekly DDP is effective with manageable toxicity in advanced SCCHN (except hypopharynx). In multivariate analysis low albumin emerged as poor prognostic factor. This is one of the largest series from India reporting experience with weekly DDP in SCCHN.