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Ann Surg Oncol (2012) 19:19801987 DOI 10.1245/s10434-012-2219-4
ORIGINAL ARTICLE HEAD AND NECK ONCOLOGY
Comparison of Acute Toxicities in Two Primary Chemoradiation Regimens in the Treatment of Advanced Head and Neck Squamous Cell Carcinoma
Katherine Y. Fan, BS1, Hrishikesh Gogineni, BS2, David Zaboli, BS1, Spencer Lake, BS1, Marianna L. Zahurak, MS3, Simon R. Best, MD4, Marshall A. Levine, MD1,5, Mei Tang, MD5, Eva S. Zinreich, MD6, John R. Saunders, MD7, Joseph A. Califano, MD4,7, Ray G. Blanco, MD7, Sara I. Pai, MD, PhD4, Barbara Messing, MA, CCC-SLP7, and Patrick K. Ha, MD4,7
1Johns Hopkins University School of Medicine, Baltimore, MD; 2Case Western Reserve University School of Medicine, Cleveland, OH; 3Department of Oncology, Division of Oncology Biostatistics, Johns Hopkins Medical Institution, Baltimore, MD; 4Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institution, Baltimore, MD; 5Department of Medical Oncology, Sandra & Malcolm Berman Cancer Institute, Greater Baltimore Medical Center, Baltimore, MD; 6Department of Radiation Oncology, Sandra & Malcolm Berman Cancer Institute, Greater Baltimore Medical Center, Baltimore, MD; 7Milton J. Dance Jr. Head and Neck Center, Greater Baltimore Medical Center, Baltimore, MD
ABSTRACTPurpose. The optimal dosage and frequency of platinum-based chemoradiotherapy (CRT) regimen for treating advanced head and neck squamous cell carcinoma remains unresolved. This study aims to compare the toxicity and efcacy of weekly versus more dose-intensive cisplatin-based CRTs.
Methods. We reviewed 155 stage III/IV head and neck squamous cell carcinoma patients with no evidence of distant metastasis treated with one of two CRT regimens from 2000 to 2010 at Greater Baltimore Medical Center. Twice-daily radiation was provided as a split course over a 45-day period. Regimen A consisted of concomitant cisplatin (30 mg/m2/1 h) weekly for 6 cycles; regimen B consisted of concomitant cisplatin (12 mg/m2/1 h) and 5-uorouracil (600 mg/m2/20 h) on days 1 through 5 and days 29 through33. Main outcome measures included acute toxicities (myelosuppression, neurotoxicity, nephrotoxicity, gastrointestinal dysfunction), unplanned hospitalizations, and disease control at 12 months.
Results. Patients on regimen A were much less likely to experience ototoxicity due to their treatment (0% vs. 9.8%, P = 0.04). They were more likely to experience thrombocytopenia acutely (46% vs. 26%, P = 0.02), but the toxicity was not limiting (grade 12). No signicant differences exist in the incidence of other toxicities or unplanned...