Background

Cisplatin is commonly used in patients with locally advanced head and neck cancer who receive chemoradiation treatment. The standard dose of cisplatin based on randomized controlled trials is 100mg/m², given every 3 weekly during definitive radiotherapy. Although efficacious, this is associated with high acute morbidity, requiring intensive supportive care and attendant resource implications. This study investigated the tolerability of weekly cisplatin (40mg/m²) compared to standard dose in terms of acute toxicities, hospital admission rate and delivery of chemotherapy treatment.

Method

A retrospective audit was performed in patients with locally advanced head and neck cancer patients who had received concomitant chemoradiation between January 2010 and January 2012. Information on acute toxicities, hospital admissions, and treatment were collected from electronic records of patients.

Results

Forty-eight patients were included. All completed 6.5 weeks of definitive radiotherapy (66Gy in 33 fractions). 50% patients received weekly (40mg/m²) cisplatin concomitantly with radiotherapy and 50% received 3 weekly (100mg/m²) cisplatin. The rate of grade 3 toxicities was higher in the 100mg/m² group compared to 40mg/m² group (nausea 25% vs. 12.5%, mucositis 58% vs. 21%, dysphagia 45% vs. 24% and renal impairment 62.5% vs. 8.3%, respectively). The rate of grade 3 haematological toxicity was similar in both groups. 83% in the 100mg/m² group required hospital admission with median length of hospital stay of 14 days whereas only 58% in the 40mg/m² group required admission with median length of stay of 5 days. 54% of 100mg/m² patients completed 2 planned cycles of chemotherapy, with 17% of patients experiencing a delay in cycle and subsequent dose reduction. 88% of 40mg/m² patients completed ≥ 5 planned cycles and only 8% experienced delay and dose reduction.

Conclusion

Concomitant weekly cisplatin with radical radiotherapy is feasible and generally well tolerated.