Weekly vs. daily low dose cisplatin in chemoradiation of locally advanced head and neck cancers: Comparison of compliance and clinical outcomes

Abstract

Aim: Concurrent cisplatin with radiotherapy improves outcomes in locally advanced squamous cell carcinomas of the head and neck cancers. Cisplatin has been used in different doses in various schedules. The present study is designed to evaluate the compliance, clinical outcomes, and long-term side effects in two different dose schedules of cisplatin used as concurrent therapy with radiotherapy. Materials and Methods: A total of 50 patients were included in the study from November 2015 to March 2017 with 25 patients in each group. The total radiotherapy dose planned was 70 Gy/35 fractions in 7 weeks, along with either cisplatin 35 mg/m2 weekly (Group I) or 6 mg/m2 daily (Group II). Assessment of toxicity was done by the RTOG scoring criteria. The WHO Response criterion was used to assess clinical response. Results: The compliance for radiotherapy treatment (80% vs. 84%) and chemotherapy cycles (52% vs. 60%) was almost similar in both the groups with no statistical difference seen. At the end of 3 months, Group II (60%) had better complete response than Group I (40%), although the difference was not statistically significant (P = 0.08). During treatment, no Grade III/IV hemoglobin toxicity was observed in either of the groups. Grade III/IV mucositis was predominant in Group II with 40% vs. 24%; P-value was not statistically significant. No Grade III/IV xerostomia was seen in either of the groups. The median follow-up of patients is 15 months. The median overall survival (11 vs. 6 months) and disease-free survival (4 vs. 2 months) are less in patients who received daily cisplatin infusion as concurrent therapy, although the difference is not statistically significant. Conclusion: Low dose cisplatin with radiotherapy appears feasible and is a logistically suitable “outpatient” option without increasing long-term toxicity.