Dose Delivery Analysis of Weekly Versus 3-Weekly Cisplatin Concurrent With Radiation Therapy for Locally Advanced Nasopharyngeal Carcinoma (NPC)

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Objective:The purpose of this study was to analyze the dose delivery and toxicity of weekly cisplatin versus high-dose cisplatin given every 3 weeks in a tertiary oncology clinic.Methods:From January 2000 to July 2009, patients with biopsy-proven nasopharyngeal carcinoma receiving concurrent cisplatin with curative-intent radiation therapy (RT) were included. Before 2005, most patients received cisplatin (Q3) (100 mg/m2 intravenously days 1, 22, and 43 of RT) and 3-dimensional conformal RT (66 Gy, 33 fractions). After 2005, most patients received weekly cisplatin (Q1) (40 mg/m2 intravenously weekly for 7 wk of RT) and intensity-modulated radiotherapy (70 Gy, 35 fractions).Results:Seventy-three patients were analyzed: 45 for Q1 and 28 for Q3. Cumulative doses ≥200 mg/m2 were achieved in 80% of Q1 and 86% of Q3 patients, respectively. Dose reduction due to toxicity was required in 2/45 (4%) of Q1 patients compared with 11/28 (39%) of Q3 patients (P=0.0003). Toxicities in Q1 and Q3 patients included: hospitalization for acute toxicity in 20% and 35.7%; mean weight loss 10.85% and 8.75%; percutaneous endoscopic gastrostomy tube placement in 25.6% and 29.6%; and grade 3 dehydration in 11.1% and 17.9%, respectively. Median follow-up time was 3 years for Q1 and 6 years for Q3 patients. Median disease-free survival was 46 months for the Q1 group and 53 months for the Q3 group (P=0.667). There was no difference in overall survival between Q1 and Q3.Conclusions:In this series, weekly 40 mg/m2 cisplatin and 3-weekly 100 mg/m2 cisplatin showed similar deliverability, toxicity profiles, and outcomes. At our center, weekly cisplatin is standard of care for patients with locally advanced nasopharyngeal carcinoma undergoing chemoradiotherapy.

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