Toxicity of two cisplatin-based radiochemotherapy regimens for the treatment of patients with stage III/IV head and neck cancer

Background. This nonrandomized study compared 2 radiochemotherapy regimens for toxicity in 128 patients with stage III/IV head and neck cancer. Methods. Patients received conventionally fractionated radiotherapy. The total dose to primary tumor and involved lymph nodes did depend on preceding surgery. Patients received 66 to 70 Gy if surgery was not performed, 60 to 66 Gy after R0 resection, 66 Gy after R1 resection, and 70 to 72 Gy after R2 resection. Concurrent chemotherapy consisted of 3 courses cisplatin (100 mg/m ²/d1,22,43) (group A, N = 61) or 2 courses cisplatin (20 mg/m ²/d1-5 + 29-33)/5-fluorouracil (5-FU) (600 mg/m²/d1-5 + 29-33) (group B, N = 67). Results. Acute toxicity was more severe in group A, especially nausea/vomiting (p = .002), nephrotoxicity (p = .001), ototoxicity (p = .034), and hematotoxicity (p = .049). Forty-eight percent of group A and 10% of group B patients could not complete chemotherapy due to toxicity (p = .018). Late toxicity was similar (p= .99). Conclusion. Two courses of fractionated cisplatin (20 mg/m²/d) and 5-FU were associated with significantly less acute toxicity than were 3 courses cisplatin (100 mg/m²/d).