P2-1-2 - Opioid Requirements to Control Mucositis During Chemoradiotherapy in Head and Neck Cancer: Cisplatin Vs. Cetuximab

Abstract

Background: Radiation-induced mucositis is considered mild in cetuximab-based bioradiotherapy (BRT) compared to cisplatin-based chemoradiotherapy (CRT) among head and neck cancer patients. We investigated the difference of opioid usage in CRT and BRT for head and neck cancer.Patients and methods: A single-center, retrospective study was conducted on head and neck cancer patients who started to receive either curative-intent CRT or BRT of 66-70Gy between January 2013 and December 2013. Patients were treated with cisplatin 80 mg/m2 every 3 weeks in CRT group, while cetuximab 400 mg/m2 at the first cycle then 250 mg/m2 weekly in BRT group. Treatment was decided through cancer board, in which patients' age, complications and preference were considered. Regular opioid administration dosage during irradiation and 28 days post-irradiation were converted into cumulative dose of fentanyl. Two-sided t-test at alpha = 0.05 was performed to compare the opioid requirements to control mucositis-induced pain between CRT and BRT groups.Results: A total of 50 patients were enrolled in the study; of which 35 were treated with CRT, and 15 were treated with BRT. Distribution of primary sites was naopharynx in 2(4%), oropharynx in 26(52%), hypopharynx in 8(16%) and larynx in 11(22%) patients. 22 (44%) patients was evaluated as at stage IV, and IMRT was administered to 25 (50%) of study population. Opioid requirements in fentanyl dose was significantly lower at average dose of 15.9 mg (SD: 14.8) in CRT group (n = 35), compared to 5.6mg (SD: 9.7) in BRT group (n = 15); t (48) = 2.46, p = 0.02.Conclusion: Opioid requirements to control mucositis-induced pain during radiotherapy for HNSCC were significantly lower in patients who received BRT compared to patients who received CRT. Further multivariate analyses with presumed confounding factors, such as status of hospitalization and physician in charge, are warranted with sufficient sample size that limited multiple regression in the current study.