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Radiotherapy potentiation with weekly cisplatin compared to standard every 3 weeks cisplatin chemotherapy for locoregionally advanced head and neck squamous cell carcinoma.

Fayette J, Molin Y, Lavergne E, Montbarbon X, Racadot S, Poupart M, Ramade A, Zrounba P, Ceruse P, Pommier P - Drug Des Devel Ther (2015)

Bottom Line: With a median follow-up of 73 months (95% confidence interval [CI] [68.9-76.2]), OS was found to be significantly better with q3w (5 years OS: 62.3%; 95% CI [51.6-71.3]) than with q1w cisplatin (5 years OS: 52.6%; 95% CI [44.5-60.0]) (log-rank P=0.0146).Though q1w seemed to be safer than q3w according to the descriptive analysis, multivariate analyses failed to conclude about its efficiency.Therefore, we conclude that the q3w schedule should remain the standard and prospective comparisons are needed.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, University of Lyon, France.

ABSTRACT

Background: Despite its toxicity, cisplatin every 3 weeks (q3w) is the standard potentiation of chemo-radiotherapy for head and neck squamous cell carcinoma. This study aimed to determine whether weekly cisplatin (q1w) could be a safe and effective alternative.

Patients and methods: Two hundred and sixty-two patients with head and neck squamous cell carcinoma, irradiated in our institution with cisplatin (q1w or q3w) between January 2004 and December 2008, were retrospectively included. Overall survival (OS) and progression-free survival (PFS) were evaluated. Survival distributions were estimated by Kaplan-Meier method and compared using the log-rank test. Prognostic effect of chemo-radiotherapy was explored using Cox model.

Results: A total of 165 and 97 patients received q1w and q3w cisplatin, respectively. Median age, stage at diagnosis, alcohol consumption, intensity-modulated radiation therapy use, median weight, and renal failure before radiotherapy were significantly different, showing lower risk in the q3w group. Q3w cisplatin was found to be more toxic in terms of weight loss, renal failure, worse chemotherapy plan completion, and grade 3/4 mucositis and dermatitis, with more patients requiring analgesics, secondary hospitalization, and radiotherapy interruption (≥3 days), and patients affected by long-term toxicities. With a median follow-up of 73 months (95% confidence interval [CI] [68.9-76.2]), OS was found to be significantly better with q3w (5 years OS: 62.3%; 95% CI [51.6-71.3]) than with q1w cisplatin (5 years OS: 52.6%; 95% CI [44.5-60.0]) (log-rank P=0.0146). More number of patients treated according to the q1w schedule experienced a recurrence: 47.3% vs 30.9% (P=0.009). Thus, the PFS for q3w schedule was found to be globally better (5 years PFS: 55.8%; 95% CI [45.0-65.3]) than for q1w schedule (5 years PFS: 43.6%; 95% CI [35.9-51.0]) (log-rank P=0.0161). However, both multivariate analyses, OS and PFS, produce no significant hazard ratio for chemo-radiotherapy modality once adjusted on unbalanced covariates according to the descriptive analysis.

Conclusion: Though q1w seemed to be safer than q3w according to the descriptive analysis, multivariate analyses failed to conclude about its efficiency. Therefore, we conclude that the q3w schedule should remain the standard and prospective comparisons are needed.

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Related in: MedlinePlus

Time to progression according to the type of chemotherapy.Abbreviations: q1w, once weekly; q3w, every 3 weeks; pts, patients.
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f3-dddt-9-6203: Time to progression according to the type of chemotherapy.Abbreviations: q1w, once weekly; q3w, every 3 weeks; pts, patients.

Mentions: Since patients with LAHNSCC have a lot of comorbidities, the TTP should also be a good parameter to compare the two schedules. Among the 125 deceased patients, 88 died of cancer whereas 37 died of comorbidities. The 88 patients who died of cancer had previously relapsed. The 3 years and the 5 years TTP rates for all the patients were 64.0% (95% CI [57.7–69.7]) and 57.8% (95% CI [51.3–63.9]), respectively. By taking the type of potentiation into consideration, TTP univariate analysis favored the q3w schedule (log-rank P=0.0072) with a 3 years TTP rate of 71.9% (95% CI [61.4–79.9]) vs 59.4% for patients treated with q1w (95% CI [51.2–66.7]) and 5 years TTP rate of 68.9% (95% CI [58.1–77.5]) vs 51.4% for q1w group (95% CI [43.1–59.1]) (Figure 3).


Radiotherapy potentiation with weekly cisplatin compared to standard every 3 weeks cisplatin chemotherapy for locoregionally advanced head and neck squamous cell carcinoma.

Fayette J, Molin Y, Lavergne E, Montbarbon X, Racadot S, Poupart M, Ramade A, Zrounba P, Ceruse P, Pommier P - Drug Des Devel Ther (2015)

Time to progression according to the type of chemotherapy.Abbreviations: q1w, once weekly; q3w, every 3 weeks; pts, patients.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664534&req=5

f3-dddt-9-6203: Time to progression according to the type of chemotherapy.Abbreviations: q1w, once weekly; q3w, every 3 weeks; pts, patients.
Mentions: Since patients with LAHNSCC have a lot of comorbidities, the TTP should also be a good parameter to compare the two schedules. Among the 125 deceased patients, 88 died of cancer whereas 37 died of comorbidities. The 88 patients who died of cancer had previously relapsed. The 3 years and the 5 years TTP rates for all the patients were 64.0% (95% CI [57.7–69.7]) and 57.8% (95% CI [51.3–63.9]), respectively. By taking the type of potentiation into consideration, TTP univariate analysis favored the q3w schedule (log-rank P=0.0072) with a 3 years TTP rate of 71.9% (95% CI [61.4–79.9]) vs 59.4% for patients treated with q1w (95% CI [51.2–66.7]) and 5 years TTP rate of 68.9% (95% CI [58.1–77.5]) vs 51.4% for q1w group (95% CI [43.1–59.1]) (Figure 3).

Bottom Line: With a median follow-up of 73 months (95% confidence interval [CI] [68.9-76.2]), OS was found to be significantly better with q3w (5 years OS: 62.3%; 95% CI [51.6-71.3]) than with q1w cisplatin (5 years OS: 52.6%; 95% CI [44.5-60.0]) (log-rank P=0.0146).Though q1w seemed to be safer than q3w according to the descriptive analysis, multivariate analyses failed to conclude about its efficiency.Therefore, we conclude that the q3w schedule should remain the standard and prospective comparisons are needed.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, University of Lyon, France.

ABSTRACT

Background: Despite its toxicity, cisplatin every 3 weeks (q3w) is the standard potentiation of chemo-radiotherapy for head and neck squamous cell carcinoma. This study aimed to determine whether weekly cisplatin (q1w) could be a safe and effective alternative.

Patients and methods: Two hundred and sixty-two patients with head and neck squamous cell carcinoma, irradiated in our institution with cisplatin (q1w or q3w) between January 2004 and December 2008, were retrospectively included. Overall survival (OS) and progression-free survival (PFS) were evaluated. Survival distributions were estimated by Kaplan-Meier method and compared using the log-rank test. Prognostic effect of chemo-radiotherapy was explored using Cox model.

Results: A total of 165 and 97 patients received q1w and q3w cisplatin, respectively. Median age, stage at diagnosis, alcohol consumption, intensity-modulated radiation therapy use, median weight, and renal failure before radiotherapy were significantly different, showing lower risk in the q3w group. Q3w cisplatin was found to be more toxic in terms of weight loss, renal failure, worse chemotherapy plan completion, and grade 3/4 mucositis and dermatitis, with more patients requiring analgesics, secondary hospitalization, and radiotherapy interruption (≥3 days), and patients affected by long-term toxicities. With a median follow-up of 73 months (95% confidence interval [CI] [68.9-76.2]), OS was found to be significantly better with q3w (5 years OS: 62.3%; 95% CI [51.6-71.3]) than with q1w cisplatin (5 years OS: 52.6%; 95% CI [44.5-60.0]) (log-rank P=0.0146). More number of patients treated according to the q1w schedule experienced a recurrence: 47.3% vs 30.9% (P=0.009). Thus, the PFS for q3w schedule was found to be globally better (5 years PFS: 55.8%; 95% CI [45.0-65.3]) than for q1w schedule (5 years PFS: 43.6%; 95% CI [35.9-51.0]) (log-rank P=0.0161). However, both multivariate analyses, OS and PFS, produce no significant hazard ratio for chemo-radiotherapy modality once adjusted on unbalanced covariates according to the descriptive analysis.

Conclusion: Though q1w seemed to be safer than q3w according to the descriptive analysis, multivariate analyses failed to conclude about its efficiency. Therefore, we conclude that the q3w schedule should remain the standard and prospective comparisons are needed.

Show MeSH
Related in: MedlinePlus