Noronha V, Sharma V, Joshi A, Patil V M, Laskar S G, Prabhash K
Department of Medical Oncology, Tata Memorial Hospital, Dr E Borges Marg, Parel, Mumbai, Maharashtra, India.
Department of Hematology, Bone Marrow Transplantation Unit, Christian Medical College, Vellore, Tamil Nadu, India.
Indian J Cancer. 2017 Apr-Jun;54(2):453-457. doi: 10.4103/ijc.IJC_320_17.
Cisplatin-based chemoradiation (CTRT) is the standard of care in locally advanced head and neck cancers. Limited treatment options are available in patients unfit for cisplatin.
This audit was carried out to study the toxicities, tolerance, and outcomes of carboplatin-based CTRT in patients who are not eligible for cisplatin.
A total of 63 locally advanced head and neck cancer patients treated between January 2011 and October 2015 were administered carboplatin-based CTRT. The dose of carboplatin was equivalent to area under the curve equivalent to 2 administered once a week for a maximum of 7 cycles. Toxicity was coded as per the CTCAE version 4.03. SPSS software version 16 was used for statistical analysis.
Descriptive statistics was performed. Progression-free survival (PFS) and overall survival (OS) were estimated by Kaplan-Meier survival analysis. Cox proportional hazard model was used for identifying factors affecting PFS and OS.
The reasons for patients being unfit for cisplatin were low serum creatinine clearance in 41 (65.07%), sensorineural hearing loss in 18 (28.57%), uncontrolled medical comorbidities in 3 (4.76%), and old age in 1 patient (1.6%). 53 patients (84.1%) completed planned radiotherapy. The median number of chemotherapy cycles administered was 6. Grade 3-4 toxicities were seen in 32 patients (50.8%). The median OS and PFS were 28 months (95% confidence interval [CI]: 20.9-34.6 months) and 17 months (95% CI: 08.2-25.7 months), respectively. Age was the only factor significantly affecting OS and PFS.
Carboplatin-based CTRT is well tolerated in patients unfit for cisplatin and seems to have superior outcomes than those reported in radical radiotherapy studies.
基于顺铂的放化疗（CTRT）是局部晚期头颈癌的标准治疗方案。对于不适合使用顺铂的患者，可用的治疗选择有限。
本审计旨在研究不适合使用顺铂的患者接受基于卡铂的CTRT的毒性、耐受性和疗效。
2011年1月至2015年10月期间，共63例局部晚期头颈癌患者接受了基于卡铂的CTRT。卡铂剂量相当于曲线下面积为2，每周给药1次，最多7个周期。毒性按照CTCAE 4.03版进行编码。使用SPSS软件16版进行统计分析。
进行描述性统计。采用Kaplan-Meier生存分析估计无进展生存期（PFS）和总生存期（OS）。使用Cox比例风险模型确定影响PFS和OS的因素。
患者不适合使用顺铂的原因包括41例（65.07%）血清肌酐清除率低、18例（28.57%）感音神经性听力损失、3例（4.76%）未控制的内科合并症以及1例（1.6%）老年患者。53例患者（84.1%）完成了计划的放疗。化疗周期的中位数为6个。32例患者（50.8%）出现3-4级毒性。OS和PFS的中位数分别为28个月（95%置信区间[CI]：20.9 - 34.6个月）和17个月（95%CI：08.2 - 25.7个月）。年龄是唯一显著影响OS和PFS的因素。
基于卡铂的CTRT在不适合使用顺铂的患者中耐受性良好，似乎比根治性放疗研究报告的结果更优。
