Decrease in treatment intensity predicts worse outcome in patients with locally advanced head and neck squamous cell carcinoma undergoing radiochemotherapy.
Aged
Carboplatin
/ adverse effects
Chemoradiotherapy
/ adverse effects
Cisplatin
/ adverse effects
Dermatitis
/ etiology
Female
Head and Neck Neoplasms
/ mortality
Humans
Induction Chemotherapy
/ adverse effects
Leukopenia
/ etiology
Middle Aged
Progression-Free Survival
Radiation-Sensitizing Agents
/ adverse effects
Radiotherapy Dosage
Radiotherapy, Intensity-Modulated
/ adverse effects
Retrospective Studies
Squamous Cell Carcinoma of Head and Neck
/ mortality
Stomatitis, Aphthous
/ etiology
Treatment Outcome
Xerostomia
/ etiology
HNSCC
Radiochemotherapy
Toxicity
Treatment modification
Journal
Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico
ISSN: 1699-3055
Titre abrégé: Clin Transl Oncol
Pays: Italy
ID NLM: 101247119
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
received:
14
11
2019
accepted:
02
07
2020
pubmed:
17
7
2020
medline:
15
9
2021
entrez:
17
7
2020
Statut:
ppublish
Résumé
Radiochemotherapy (RCT) is an effective standard therapy for locally advanced head and neck squamous cell carcinoma (LA-HNSCC). Nonetheless, toxicity is common, with patients often requiring dose modifications. To investigate associations of RCT toxicities according to CTCAE version 5.0 and subsequent therapy modifications with short- and long-term treatment outcomes, we studied all 193 patients with HNSCC who received RCT (70 Gy + platinum agent) at an academic center between 03/2010 and 04/2018. During RCT, 77 (41%, 95% CI 34-49) patients developed at least one ≥ grade 3 toxicity, including seven grade 4 and 3 fatal grade 5 toxicities. The most frequent any-grade toxicities were xerostomia (n = 187), stomatitis (n = 181), dermatitis (n = 174), and leucopenia (n = 98). Eleven patients (6%) had their radiotherapy schedule modified (mean radiotherapy dose reduction = 12 Gy), and 120 patients (64%) had chemotherapy modifications (permanent discontinuation: n = 67, pause: n = 34, dose reduction: n = 7, change to other chemotherapy: n = 10). Objective response rates to RCT were 55% and 88% in patients with and without radiotherapy modifications (p = 0.003), and 84% and 88% in patients with and without chemotherapy modifications (p = 0.468), respectively. Five-year progression-free survival estimates were 20% and 50% in patients with and without radiotherapy modifications (p = < 0.001), and 53% and 40% in patients with and without chemotherapy modifications (p = 0.88), respectively. Reductions of radiotherapy dose were associated with impaired long-term outcomes, whereas reductions in chemotherapy intensity were not. This suggests that toxicities during RCT should be primarily managed by modifying chemotherapy rather than radiotherapy.
Identifiants
pubmed: 32671728
doi: 10.1007/s12094-020-02447-y
pii: 10.1007/s12094-020-02447-y
pmc: PMC7936960
doi:
Substances chimiques
Radiation-Sensitizing Agents
0
Carboplatin
BG3F62OND5
Cisplatin
Q20Q21Q62J
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
543-553Références
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