AUTHOR=Hanemaaijer Saskia H. , Kok Iris C. , Fehrmann Rudolf S. N. , van der Vegt Bert , Gietema Jourik A. , Plaat Boudewijn E. C. , van Vugt Marcel A. T. M. , Vergeer Marije R. , Leemans C. René , Langendijk Johannes A. , Voortman Jens , Buter Jan , Oosting Sjoukje F. 

TITLE=Comparison of Carboplatin With 5-Fluorouracil vs. Cisplatin as Concomitant Chemoradiotherapy for Locally Advanced Head and Neck Squamous Cell Carcinoma

JOURNAL=Frontiers in Oncology

VOLUME=10

YEAR=2020

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2020.00761

DOI=10.3389/fonc.2020.00761

ISSN=2234-943X

ABSTRACT=<p><bold>Background:</bold> Chemoradiotherapy (CRT) including three cycles of cisplatin is considered the standard of care for locally advanced head and neck squamous cell carcinoma (LA-HNSCC). However, around one-third of the patients cannot complete cisplatin because of toxicity. Carboplatin plus 5-fluorouracil (carbo-5FU) is another accepted treatment option with a different toxicity profile. We compared tolerability and efficacy of concomitant carbo-5FU and cisplatin.</p><p><bold>Patients and Methods:</bold> We conducted a retrospective analysis of LA-HNSCC patients treated with CRT in two Dutch cancer centers between 2007 and 2016. All patients received intensity-modulated radiotherapy. One center routinely administered carboplatin 300–350 mg/m<sup>2</sup> at day 1, 22, and 43 followed by 5FU 600 mg/m<sup>2</sup>/day for 96 h. The other center used cisplatin 100 mg/m<sup>2</sup> at day 1, 22, and 43. The primary endpoint of this study was chemotherapy completion rate. Secondary endpoints included overall survival (OS), disease-free survival (DFS), locoregional control (LRC) and distant metastasis–free interval (DMFS), toxicity, and unplanned admissions.</p><p><bold>Results:</bold> In the carbo-5FU cohort (<italic>n</italic> = 211), 60.2% of the patients completed chemotherapy vs. 76.7% (<italic>p</italic> &lt; 0.001) of the patients in the cisplatin cohort (<italic>n</italic> = 223). Univariate analysis showed a higher risk of death in the carbo-5FU cohort [hazard ratio (HR) 1.53, 95% CI, 1.09–2.14, <italic>p</italic> = 0.01] with a 3-year OS of 65.4 vs. 76.5% for cisplatin. OS was independently associated with T and N stage and p16 status, but not with chemotherapy regimen (HR 1.08, 95% CI, 0.76–1.55, <italic>p</italic> = 0.65). Three-year DFS was 70.0% for carbo-5FU vs. 78.6% for cisplatin (HR 1.37, 95% CI, 0.93–2.01, <italic>p</italic> = 0.05). A similar outcome was observed for both LRC (HR 1.27, 95% CI, 0.74–2.09, <italic>p</italic> = 0.4) and DMFS (HR 1.08, 95% CI 0.62–1.90, <italic>p</italic> = 0.77). The risk of discontinuation for chemotherapy-associated toxicity was higher in the carbo-5FU cohort than in the cisplatin cohort (relative risk = 1.69).</p><p><bold>Conclusion:</bold> LA-HNSCC patients treated with concomitant carbo-5FU completed chemotherapy less frequently than patients treated with cisplatin. Treatment regimen was not an independent prognostic factor for OS.</p>