Definitive radiochemotherapy with weekly cisplatin in patients with head and neck cancer; single institution outcome analysis
Abstract
Purpose: The objective of this study was to evaluate the feasibility, toxicity and efficacy of definitive radiochemotherapy with weekly cisplatin in head and neck cancer in a single institutional setting. Methods: Previously untreated patients with stage II-IV head and neck cancer were included.
Radiotherapy consisted of 70 Gy/7 weeks/35 fractions. All patients received concurrent cisplatin 40 mg/m(2) weekly Results: Between 2/2002 and 8/2009, 148 consecutive patients (WHO {= 2, male to female ratio 6/1, median age 56 years) were treated.
The mean follow-up was 40 months. Tumors of the oropharynx were the most frequent (46%) and stage IV predominated (80%).
Eighty-nine percent of the patients had received the full radiation treatment as planned. Omission of weekly cisplatin occurred frequently, mainly because of hematological toxicity.
Only 64% of the patients completed at least 5 cycles of chemotherapy. Grade 3/4 mucosal toxicity developed in 32% of the patients.
The late toxicities were acceptable: 74% of the patients were able to eat solid food during the 1st post-treatment year 4 patients were not able to swallow at all during the 1st post-treatment year, requiring thus permanent feeding tube. Five cases of osteora-dionecrosis of the mandible were reported.
Three-year overall survival, locoregional control, time to progression and disease free survival were 34, 60, 52 and 29%, respectively. Conclusion: Definitive radiochemotherapy with weekly cisplatin was toxic, with high rate of morbidity and mortality in this patient population.
Five weekly cycles of 40 mg/m(2) cisplatin seem to be the dose limit for most patients. Three-year survival was significantly reduced despite the promising high initial response and locoregional control.