Correlation of deviation from intended cisplatin (CDDP) dose intensity with outcome in patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC) receiving concurrent chemoradiation (CRT)

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6052 Background: CRT with high dose CDDP 100mg/m2×3 and radiation (RT) 70Gy/35f/7weeks is a standard treatment option in patients (pts) with LA-HNSCC. Whether the delivery of less than the intended doses of CDDP is associated with worse outcomes is unknown. Non-trial LA-HNSCC pts, definitively treated with CRT, were retrospectively reviewed to investigate correlates of outcome and toxicity. Methods: All non-nasopharynx LA-HNSCC pts treated between Jan 02 and Dec 06 whose treatment intent was CRT were reviewed. LA-HNSCC pts without bulky adenopathy were eligible for altered fractionated RT alone during this period. Pts on CRT study protocols or treated with RT alone were excluded. Data collected included baseline patient and tumour characteristics, chemotherapy and RT delivery details, toxicity and clinical outcomes. Results: A total of 257 eligible pts were identified: median age 57 (27- 80), male (75%), smokers (77%), ECOG 0 (63%), ≤1 co-morbidity (77%), pre-treatment weight loss (36%), oropharynx primary (54%), T3/4 (56%), N2/3 (83%), stage IV (92%: IVA=71%, IVB=21%). Median follow-up was 21.2 months. Of 257 pts, 242 (94%) received 70Gy and 122 (47%) received intensity modulated radiation therapy (IMRT), implemented as standard therapy after 2004. Only 97 (38%) pts received all 3 cycles of CDDP commonly due to acute hematologic toxicities and weight loss. The 2 year OS and PFS were 85.0% and 64.7%. On multivariate analyses, only poorer ECOG was significant for decreased OS (p<0.001). Lower PFS was associated with <3 cycles of CDDP (p=0.035), poorer ECOG (p<0.001), non-oropharynx primary (p<0.014), T3/4 (p=0.019) and stage (p=0.028). The delivery of <3 cycles of CDDP affected local but not regional or distant PFS. Increased late grade 3 (CTCAEv3) toxicity was associated with non- IMRT (p=0.017), poorer ECOG (p<0.001), low pre-treatment Hgb (p=0.024) and N0/1 (p=0.016). Conclusions: In these predominantly stage IV pts, about 2/3 could not receive the third cycle of CDDP and had decreased local control. Further study is required to validate this and other adverse factors identified for PFS. The implementation of IMRT was associated with less late grade 3 toxicity. No significant financial relationships to disclose.