Department of Radiation Oncology, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India.
Department of Clinical Research Secretariat, ACTREC/TMH, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India.
Oral Oncol. 2022 Nov;134:106130. doi: 10.1016/j.oraloncology.2022.106130. Epub 2022 Sep 24.
Cisplatin-based concurrent chemoradiotherapy is the contemporary standard-of-care in curative-intent management of loco-regionally advanced head and neck squamous cell carcinoma. The most optimal dose-schedule of concurrent cisplatin remains debatable with widespread variability in clinical practice. High-quality evidence in favour of cisplatin-based chemoradiotherapy is largely based on high-dose cisplatin given as 100 mg/m every three-weekly for up to three cycles. However, such dosing is typically associated with high rates of significant acute hematological and renal toxicity prompting the need for alternative lesser toxic dose-schedules. Compliance to three doses of three-weekly high-dose cisplatin is reportedly suboptimal with nearly 40% of patients unable to receive the third cycle thereby achieving cumulative cisplatin dose of 200 mg/m which is generally regarded sufficient for beneficial anti-tumor effect. The most common alternative schedule is low-dose (20-50 mg/m) cisplatin once-weekly during radiotherapy. Such low-dose weekly regimens have undergone less rigorous prospective evaluation versus RT alone but continue to be widely used in co-operative group trials and routine clinical practice. In the last decade, several small prospective randomized controlled trials have reported significantly lesser toxicity and comparable disease-related outcomes with low-dose weekly cisplatin. However, two recent randomized controlled trials have re-ignited the debate globally due to their contradictory results, inferences, and conclusions. Through this commentary, we critically appraise and summarize the existing evidence-base to inform contemporary clinical practice and guide future research. There is increasingly emerging evidence that chemoradiotherapy with once-weekly cisplatin is non-inferior to three-weekly cisplatin for disease-related outcomes in curative-intent management of loco-regionally advanced head and neck cancer.
顺铂为基础的同期放化疗是局部晚期头颈部鳞状细胞癌有治愈意图的治疗的当代标准治疗。同期顺铂的最佳剂量方案仍存在争议，临床实践中差异很大。支持顺铂为基础的放化疗的高质量证据主要基于高剂量顺铂，每周 100mg/m2，最多三个周期。然而，这种剂量方案通常与严重的急性血液学和肾毒性相关，需要替代毒性较小的剂量方案。每周三次高剂量顺铂的依从性不理想，近 40%的患者无法接受第三个周期，从而实现累积顺铂剂量 200mg/m2，通常认为这足以产生有益的抗肿瘤效果。最常见的替代方案是在放疗期间每周一次低剂量（20-50mg/m2）顺铂。与单独放疗相比，这种低剂量每周方案的前瞻性评估较少，但仍广泛用于合作组试验和常规临床实践。在过去十年中，几项小型前瞻性随机对照试验报告了较低的毒性和可比的疾病相关结局，低剂量每周顺铂的毒性和可比的疾病相关结局。然而，最近的两项随机对照试验由于其矛盾的结果、推论和结论，在全球范围内重新引发了争议。通过本评论，我们批判性地评估和总结现有的证据基础，为当代临床实践提供信息，并指导未来的研究。越来越多的证据表明，每周一次顺铂的放化疗在局部晚期头颈部癌有治愈意图的治疗中与每周三次顺铂相比，在疾病相关结局方面非劣效。
