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Weekly versus every-three-weeks platinum-based chemoradiation regimens for head and neck cancer

View Article: PubMed Central - PubMed

ABSTRACT

Background: The majority of chemoradiation (CRT) trials for locally advanced head and neck squamous cell carcinoma (HNSCC) have relied on platinum-based chemotherapy regimens administered every-3-weeks. However, given the increased utilization of weekly platinum regimens, it remains unclear how different chemotherapy schedules compare regarding efficacy and toxicity.

Methods: We retrospectively identified 212 patients with HNSCC who were treated at a single academic medical center with concurrent platinum-based CRT given weekly (N = 68) or every-three-weeks (N = 144). JMP version 10 (SAS Institute) was used for statistical analysis. Discrete variables were compared with the chi-square test and differences in the medians were assessed using the Wilcoxon test. Survival curves were constructed using the Kaplan-Meier method and significance was assessed using the log rank test. For univariate analysis and multivariate analysis, we used Cox proportional hazard or logistic regression models to compare differences in survival or differences in categorical variables, respectively.

Results: Patients receiving weekly platinum regimens were more likely to be older (median age 61.4 vs. 55.5 y; P < .001), have high or very high Charlson comorbidity index (45.6% vs. 27.8%; P = .01), and receive carboplatin-based chemotherapy (6.3% vs. 76.5%; P < .001). Weekly and every-3-week platinum regimens had similar locoregional control (HR 1.10; 95% CI 0.63–1.88; P = .72), progression-free survival (HR 1.13; 95% CI 0.75–1.69; P = .55), and overall survival (HR 1.11; 95% CI 0.64–1.86; P = .71). Every-3-weeks platinum regimens were associated with increased days of hospitalization (median: 3 days vs. 0 days; P = .03) and acute kidney injury (AKI) during radiotherapy (50.0% vs. 22.1%; P < .001). On multivariate analysis, AKI was significantly associated with every-3-weeks regimens (OR: 24.38; 95% CI 3.00–198.03; P = .003) and high comorbidity scores (OR: 2.74; 95% CI 2.15–5.99; P = .01).

Conclusions: Our results suggest that every-3-weeks and weekly platinum-containing CRT regimens have similar disease control but weekly platinum regimens are associated with less acute toxicity.

Electronic supplementary material: The online version of this article (doi:10.1186/s40463-016-0175-x) contains supplementary material, which is available to authorized users.

No MeSH data available.


Related in: MedlinePlus

Kaplan-Meier curves for (a) locoregional control, (b) progression-free survival, and (c) overall survival in patients receiving weekly carboplatin versus every-3-weeks cisplatin chemoradiation regimens. The log rank test was used to assess for differences in outcomes
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Fig2: Kaplan-Meier curves for (a) locoregional control, (b) progression-free survival, and (c) overall survival in patients receiving weekly carboplatin versus every-3-weeks cisplatin chemoradiation regimens. The log rank test was used to assess for differences in outcomes

Mentions: With median follow-up of 23.7 months for the entire cohort, 85 patients experienced disease progression (28 patients in the weekly chemotherapy group and 57 patients in the every-3-weeks chemotherapy group). The majority of failures were due to locoregional progression (20 patients in the weekly chemotherapy group and 38 patients in the every-3-weeks chemotherapy group). At the time of analysis, 63 patients had died (20 patients in the weekly chemotherapy group and 43 patients in the every-3-weeks chemotherapy group). As shown in Fig. 1, weekly chemotherapy in comparison to every-3-weeks chemotherapy was not associated with worse LRC (2y LRC ± SE 65.7 ± 6.4% vs. 69.7 ± 4.4%; HR 1.10; 95% CI 0.63–1.88; P = .72), PFS (2y PFS ± SE 50.7 ± 6.4% vs. 53.1 ± 4.6%; HR 1.13; 95% CI 0.75–1.69; P = .55), or OS (2y OS ± SE 69.9 ± 6.4% vs. 75.7 ± 4.0%; HR 1.11; 95% CI 0.64–1.86; P = .71). As shown in Fig. 2, weekly carboplatin in comparison to bolus cisplatin was not associated with worse LRC (2y LRC ± SE 72.7 ± 6.9% vs. 71.1 ± 4.5%; HR 0.90; 95% CI 0.45–1.70; P = .76), PFS (2y PFS ± SE 55.8 ± 7.4% vs. 53.3 ± 4.8%; HR 0.96; 95% CI 0.59–1.52; P = .88), or OS (2y OS ± SE 71.2 ± 7.2% vs. 74.6 ± 4.3%; HR 0.96; 95% CI 0.50–1.71; P = .89).Fig. 1


Weekly versus every-three-weeks platinum-based chemoradiation regimens for head and neck cancer
Kaplan-Meier curves for (a) locoregional control, (b) progression-free survival, and (c) overall survival in patients receiving weekly carboplatin versus every-3-weeks cisplatin chemoradiation regimens. The log rank test was used to assess for differences in outcomes
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5121964&req=5

Fig2: Kaplan-Meier curves for (a) locoregional control, (b) progression-free survival, and (c) overall survival in patients receiving weekly carboplatin versus every-3-weeks cisplatin chemoradiation regimens. The log rank test was used to assess for differences in outcomes
Mentions: With median follow-up of 23.7 months for the entire cohort, 85 patients experienced disease progression (28 patients in the weekly chemotherapy group and 57 patients in the every-3-weeks chemotherapy group). The majority of failures were due to locoregional progression (20 patients in the weekly chemotherapy group and 38 patients in the every-3-weeks chemotherapy group). At the time of analysis, 63 patients had died (20 patients in the weekly chemotherapy group and 43 patients in the every-3-weeks chemotherapy group). As shown in Fig. 1, weekly chemotherapy in comparison to every-3-weeks chemotherapy was not associated with worse LRC (2y LRC ± SE 65.7 ± 6.4% vs. 69.7 ± 4.4%; HR 1.10; 95% CI 0.63–1.88; P = .72), PFS (2y PFS ± SE 50.7 ± 6.4% vs. 53.1 ± 4.6%; HR 1.13; 95% CI 0.75–1.69; P = .55), or OS (2y OS ± SE 69.9 ± 6.4% vs. 75.7 ± 4.0%; HR 1.11; 95% CI 0.64–1.86; P = .71). As shown in Fig. 2, weekly carboplatin in comparison to bolus cisplatin was not associated with worse LRC (2y LRC ± SE 72.7 ± 6.9% vs. 71.1 ± 4.5%; HR 0.90; 95% CI 0.45–1.70; P = .76), PFS (2y PFS ± SE 55.8 ± 7.4% vs. 53.3 ± 4.8%; HR 0.96; 95% CI 0.59–1.52; P = .88), or OS (2y OS ± SE 71.2 ± 7.2% vs. 74.6 ± 4.3%; HR 0.96; 95% CI 0.50–1.71; P = .89).Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: The majority of chemoradiation (CRT) trials for locally advanced head and neck squamous cell carcinoma (HNSCC) have relied on platinum-based chemotherapy regimens administered every-3-weeks. However, given the increased utilization of weekly platinum regimens, it remains unclear how different chemotherapy schedules compare regarding efficacy and toxicity.

Methods: We retrospectively identified 212 patients with HNSCC who were treated at a single academic medical center with concurrent platinum-based CRT given weekly (N = 68) or every-three-weeks (N = 144). JMP version 10 (SAS Institute) was used for statistical analysis. Discrete variables were compared with the chi-square test and differences in the medians were assessed using the Wilcoxon test. Survival curves were constructed using the Kaplan-Meier method and significance was assessed using the log rank test. For univariate analysis and multivariate analysis, we used Cox proportional hazard or logistic regression models to compare differences in survival or differences in categorical variables, respectively.

Results: Patients receiving weekly platinum regimens were more likely to be older (median age 61.4 vs. 55.5 y; P < .001), have high or very high Charlson comorbidity index (45.6% vs. 27.8%; P = .01), and receive carboplatin-based chemotherapy (6.3% vs. 76.5%; P < .001). Weekly and every-3-week platinum regimens had similar locoregional control (HR 1.10; 95% CI 0.63–1.88; P = .72), progression-free survival (HR 1.13; 95% CI 0.75–1.69; P = .55), and overall survival (HR 1.11; 95% CI 0.64–1.86; P = .71). Every-3-weeks platinum regimens were associated with increased days of hospitalization (median: 3 days vs. 0 days; P = .03) and acute kidney injury (AKI) during radiotherapy (50.0% vs. 22.1%; P < .001). On multivariate analysis, AKI was significantly associated with every-3-weeks regimens (OR: 24.38; 95% CI 3.00–198.03; P = .003) and high comorbidity scores (OR: 2.74; 95% CI 2.15–5.99; P = .01).

Conclusions: Our results suggest that every-3-weeks and weekly platinum-containing CRT regimens have similar disease control but weekly platinum regimens are associated with less acute toxicity.

Electronic supplementary material: The online version of this article (doi:10.1186/s40463-016-0175-x) contains supplementary material, which is available to authorized users.

No MeSH data available.


Related in: MedlinePlus