Chemoradiation of locally advanced squamous cell carcinoma of the head-and-neck (LASCCHN): Is 20 mg/m2 cisplatin on five days every four weeks an alternative to 100 mg/m2 cisplatin every three weeks?

SummaryObjectives To compare chemoradiation with 100 mg/m² cisplatin every three weeks to 20 mg/m² on five days every four weeks for locally advanced squamous cell carcinoma of the head-and-neck (LASCCHN). Materials and methods In 230 patients receiving chemoradiation for LASCCHN, 100 mg/m² cisplatin every three weeks (N = 126) and 20 mg/m² cisplatin on five days every four weeks (N = 104) were retrospectively compared. Chemoradiation plus eleven characteristics (T-/N-classification, performance score, gender, age, tumor site, grading, surgery, radiation technique, pre-chemoradiation hemoglobin, cumulative cisplatin dose) were analyzed for locoregional control (LRC), metastases-free survival (MFS) and overall survival (OS). Chemoradiation groups were compared for adverse events. Results On univariate analyses, chemoradiation had no impact on LRC (p = 0.53), MFS (p = 0.67) and OS (p = 0.14). On multivariate analysis of LRC, T-classification (p = 0.045) and hemoglobin (p < 0.001) were significant. On multivariate analysis of MFS, performance score (p = 0.028) was significant. On multivariate analysis of OS, performance score (p = 0.009) and hemoglobin levels (p = 0.002) achieved significance. Chemoradiation with 100 mg/m² cisplatin was associated with more pneumonia/sepsis (p = 0.003), grade ≥2 nausea/vomiting (p < 0.001), grade ≥2 nephrotoxicity (p = 0.005), grade ≥2 xerostomia (p = 0.002), grade ≥3 hematotoxicity (p = 0.052) and grade ≥2 ototoxicity (p = 0.048). Concluding statement 20 mg/m² cisplatin on five days every four weeks was associated with fewer adverse events than 100 mg/m² cisplatin every three weeks. 100 mg/m² cisplatin was not significantly superior to 20 mg/m² cisplatin regarding LRC, MFS and OS. Given the limitations of a retrospective study, 20 mg/m² cisplatin appeared preferable. The results should be confirmed in a randomized trial.