Long-term results of low dose daily cisplatin chemotherapy used concurrently with modestly accelerated radiotherapy in locally advanced squamous cell carcinomas of the head neck cancer region

Introduction: Concurrent single agent cisplatin (CDDP) with radiotherapy (RT) improves outcomes in locally advanced squamous cell carcinomas of the head neck (LA-SCCHN). CDDP at 100 mg/m ² at 3 weekly intervals raise compliance, hospitalization, and supportive care issues. Low dose daily CDDP was delivered with RT to evaluate its compliance, long-term safety and efficacy. Patients and Methods: During the period of month between November 2005 and May 2007, 52 patients of stage III/IV LA-SCCHN were given with conventional RT in a phased manner (dose-70 Gy/35 fractions/6 weeks) along with daily CDDP (6 mg/m ² ; capped 10 mg-30 cycles) over 6 weeks. No hospitalization or antiemetic cover was planned. Compliance, acute and late toxicity were recorded as per Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer grading system and survival outcomes were evaluated. Results : The median follow-up was 63 months. 43 (83%) cases complied with RT schedule and >28 cycles of CDDP was administered in 38 (73%) cases. Confluent mucositis was seen in 65%, Grade III/IV dysphagia in 67%; 77% required enteral feed and hospitalization in 15%. There were four treatment related deaths. At 5 years, the loco-regional control was 25% (median-11 months) and the overall survival was 31% (median-11 months). The 5 years actuarial rates of late Grade III/IV toxicity was 24%. Late swallowing difficulty/aspiration were seen in 17%; xerostomia-40%; ototoxicity-6%; nephrotoxicity-4%; and no second malignancy. Conclusion: Low dose cisplatin with moderately accelerated RT schedule appears feasible and logistically suitable "out-patient" option without increasing long-term toxicity in LA-SCCHN cancer region.