Clinic for Radiotherapy and Special Oncology of the Hannover Medical School, Hannover, Germany;
Clinic for Radiotherapy and Special Oncology of the Hannover Medical School, Hannover, Germany.
In Vivo. 2022 Mar-Apr;36(2):821-832. doi: 10.21873/invivo.12769.
BACKGROUND/AIM: The implementation of a platinum-containing regimen is recommended for definitive and adjuvant therapy of patients with locally advanced head and neck tumour. We compared the conditions for the use of cisplatin or carboplatin/paclitaxel or for changing between these two regimens on a clinic-specific basis.
We evaluated 150 patients with advanced head and neck squamous cell carcinoma who received simultaneous radiochemotherapy at our institution between 2012 and 2017. Chemotherapy with weekly doses of cisplatin (40 mg/m, group 1) or, in cases of impaired renal and/or cardiac function, with weekly doses of carboplatin AUC2 and paclitaxel (45 mg/m, group 2), was performed as a first-choice therapy. If toxicities occurred in group 1, treatment was switched to the carboplatin/paclitaxel regimen (group 3). Patient- and therapy-related parameters, toxicity and survival data were compared across groups.
We examined 99, 30, and 21 patients in each group who received at least 1 course of chemotherapy. Group 3 patients switched from cisplatin to carboplatin/paclitaxel after a median of 3 courses due to nephrotoxicity (95.2%). The target of at least 5 chemotherapy courses was most frequently achieved by patients in group 1 (69.7%), followed by group 3 (61.9%) and then group 2 (40.0%). Multivariate analysis revealed that patients who switched groups were more likely to be over 60 years old (p=0.021), undergo definitive radiochemotherapy (p=0.049) and develop higher nephrotoxicity (p=0.036) than group 1 patients. Outcomes did not differ between groups.
When cisplatin application is contraindicated due to renal- or cardiotoxicity, carboplatin/paclitaxel is an appropriate option.
背景/目的：对于局部晚期头颈部肿瘤患者的明确治疗和辅助治疗，建议使用含铂方案。我们比较了基于临床具体情况使用顺铂或卡铂/紫杉醇或在这两种方案之间转换的条件。
我们评估了 2012 年至 2017 年在我们机构接受同期放化疗的 150 例晚期头颈部鳞状细胞癌患者。每周剂量顺铂（40mg/m，第 1 组）或每周剂量卡铂 AUC2 和紫杉醇（45mg/m，第 2 组）的化疗作为一线治疗。如果第 1 组发生毒性，治疗转换为卡铂/紫杉醇方案（第 3 组）。比较各组患者和治疗相关参数、毒性和生存数据。
每组至少接受 1 个疗程化疗的患者分别为 99、30 和 21 例。由于肾毒性，第 3 组患者中有 95.2%的患者在中位数 3 个疗程后将顺铂转换为卡铂/紫杉醇。第 1 组患者最常实现至少 5 个化疗疗程的目标（69.7%），其次是第 3 组（61.9%）和第 2 组（40.0%）。多变量分析显示，与第 1 组患者相比，转换组的患者年龄更大（p=0.021）、接受根治性放化疗（p=0.049）和发生更高的肾毒性（p=0.036）的可能性更大。各组之间的结局没有差异。
当由于肾毒性或心脏毒性而禁忌使用顺铂时，卡铂/紫杉醇是一种合适的选择。
