Details
Category: Volume 11 Issue 01 January 2023
Hits: 474

Title: Low dose weekly Carboplatin (AUC: 2) with radiation is an acceptable alternative for weekly cisplatin with radiation in the treatment of advanced head neck carcinoma: An observational study

Authors: Dr Md. Zillur Rahman Bhuiyan, Dr Mohammad Jahan Shams, Dr Sajib Kumar Talukdhar, Dr Mizanur Rahman, Major Dr Tarik Hasan

 DOI: https://dx.doi.org/10.18535/jmscr/v11i1.15

Abstract

Introduction: In general head and neck cancer may be treated with single modality of treatment for early-stage disease but may require multimodality treatment protocol for advanced disease. concurrent chemoradiation is the current standard protocol for patients with locally advanced squamous cell carcinoma of head neck. Carcinoma of head and neck is common clinical entity approximately 4.8% of the total new- cancer cases. In Bangladesh, according to cancer Registry Report NICRH (20015-2017), approximately 2901(10.6%) patients ire registered with head and neck cancer.

Study Design and Objective: This prospective observational study is to compare the treatment response and acute toxicities with the treatment of low dose weekly Carboplatin(AUC:2) with radiation versus weekly Cisplatin with radiation therapy for histologically proven advanced squamous cell carcinoma of head neck.

Methods: All the patients were divided in two groups. Arm-A 30 number patients received injection Carboplatin (AUC:2), i/v 30 minutes infusion weekly for 6 weeks and Arm- B 30 number patients received injection Cisplatin 30mg/m2, i/v 2 hrs. infusion weekly for 6 weeks. All patients received 66 Gray (Gy) radiation at the rate of 2Gy/day 5# in a week for 6.5 weeks.

Results: In this study ninety percent (90%) patients were smoker. The most common presenting features were cervical lymphadenopathy (Arm A 100% vs. Arm B 100%), pain (Arm A 73.33% vs. Arm B 66.67%), sore throat (Arm A 36.67% vs. Arm B 36.66%), hoarseness of voice (Arm A 36.67% vs. Arm B 36.66%) etc. Complete response of patients treated with concurrent chemoradiation with inj. Carboplatin was 63.33% in comparison to 53.33% complete response achieved in patients treated with concurrent chemoradiation with inj. Cisplatin. This difference was statistically not much more significant. Common toxicities related to treatment were mucositis, skin reaction, vomiting, nausea, weight loss, anemia, leucopenia, thrombocytopenia and diarrhea. The toxicities in Arm-A were more than that of Arm-B, but were manageable.

Conclusion: In this study the clinical response and toxicities produced by weekly low dose carboplatin with radiation in locally advanced squamous cell carcinoma of head and neck cancer were comparable to those of weekly Cisplatin schedule with radiation showed no additional efficacy. So, concurrent chemoradiotherapy with weekly Carboplatin (AUC:2) is suitable when Cisplatin is contraindicated for the patients with renal impairment.

Keywords: Carboplatin and Cisplatin: (are anti-cancer drugs). Gy(Gray): radiation unit. Concurrent chemoradiotherapy: when any anti-cancer drug added during radiotherapy

References

  1. AJCC Cancer Staging Manual. 8lh New York, NY : Spingcr- Vcrlag, 2017.
  2. Barrett A, Dobbs J, Morris S, Roques T. Practical Radiotherapy Planning, 4th edition, Hodder Arnold An Hachette UK Company,2009.
  3. Paul Symonds, Charles Deehan, Jones A. Walter & Miller Text Book of Radiotherapy, Radiation Physics, Therapy and Oncology, 8th edition, Edinburgh Churchill Livingstone, 2019; pp 355-70.
  4. Cancer Registry Report 2015-2017, Distribution of patients by systemic diagnosis. Cancer Registry Report, National Institute of Cancer Research and Hospital, Mohakhali. Dhaka, pp 10-18.
  5. Chu E, DeVita Jr VT. Physicians' Cancer Chemotherapy Drug Manual 2020, 13th edition, Jones & Bartlett learning. LLC. an Ascend Learning Company, 2020; pp303- 307.
  6. Devita Jr VT. Lawrence TS, Rosenberg SA. Cancer Principles & Practice of Oncology, 11th edition, Lippincot Williams & Wilkins. 2019; pp 424-464.
  7. Dobbs J, Banett A. Ash D. Practical radiotherapy Planning. 4th edition, UK, 2009; 88-94.
  8. Gillison ML. Koch WM, Capone RB, et al. Evidence for a causal association between human papillomavirus and a subset of head and neck cancer. J Natl Cancer Inst. 2000;92:709-720.
  9. GLOBOCAN database. 2020., International agency for research on cancer, WHO. Cancer Incidence and Mortality <http://globocan.iarc.fr>
  10. Halperin EC, Perez CA, Brady LW. Perez and Brady's Principles and Practice of Oncology, 6th edition, Lippincot Williams & Wilkins, 2013; 718-729.
  11. Hoque MM, Abe of Research Methodology and Biostatistics, la edition, 2009;pp 225.
  12. Pazdur R, Wagman LD, Camhausen KA, Hoskins WJ. Cancer Management: A Multidisciplinary' Approach, 13th edition, UBM Medica LLC, New York,2010.
  13. Perri F, Integrated therapeutic approaches in head neck cancer: the importance of multidisciplinary team management Anticancer Agents Med. Chem. 2013;13:834-43.
  14. RTOG 0417, this protocol was designed and developed by the Radiation Therapy Oncology Group (RTOG) of the American College of Radiology (ACR).
  15. Stupp R, Weichselbaum RR, Vokes EE. Combined modality therapy of head and neck cancer. Semin Oncol. 1994; 21:349-58.
  16. Symonds P, Deehan C, Mills JA, Meredith C. Walter and Miller's Textbook of Radiotherapy, 8th edition. Churchil Livingstone, London.2019;pp341-380.
  17. 2020. National Cancer Control Programmes: Policies and managerial guidelines. 2nd ed. Geneva: World Health Organization.

Corresponding Author

Dr Md. Zillur Rahman Bhuiyan

Professor, Dept. of Clinical Oncology, BSMMU