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dc.contributor.authorPrice, James
dc.contributor.authorFornacon-Wood, Isabella
dc.contributor.authorThomson, David J
dc.contributor.authorLee, Lip W
dc.contributor.authorSykes, Andrew J
dc.contributor.authorGarcez, Kate
dc.contributor.authorPrice, Gareth J
dc.contributor.authorMcPartlin, Andrew J
dc.date.accessioned2022-01-11T11:59:36Z
dc.date.available2022-01-11T11:59:36Z
dc.date.issued2021en
dc.identifier.citationPrice J, Fornacon-Wood I, Thomson D, Lee L, Sykes A, Garcez K, et al. The effect of switching to carboplatin chemo-RT for cycle 2 in cisplatin-ineligible HNSCC patients. Radiotherapy and Oncology. 2021;161:S833-S4.en
dc.identifier.urihttp://hdl.handle.net/10541/624823
dc.description.abstractPurpose or Objective For fit patients with locally advanced head and neck squamous cell carcinoma (HNSCC), radiotherapy (RT) concurrent with two cycles of high-dose cisplatin chemotherapy (CDDP) is the standard of care. It is accepted that both cycles are required in order to achieve optional survival outcomes, but some patients may become CDDP-ineligible after cycle one (e.g., secondary to renal dysfunction, peripheral neuropathy or hearing loss). For these patients, the substitution of an alternative platinum-containing regimen is an option, but there is little evidence to guide this approach. For patients who become ineligible for cycle two CDDP, this study investigates the effect on outcomes of (i) switching to carboplatin for cycle two of chemo-RT or (ii) continuing with RT alone. Materials and Methods The institutional database was searched for all patients with AJCC (7th edition) stage III-IVb HNSCC treated with definitive RT and concurrent CDDP between 2009 and 2017. Demographic, clinico-pathological and outcome data were recorded. Multivariable cox proportional hazard survival models were fit to predict overall survival (OS) and freedom from relapse (FFR), adjusting for ECOG performance status, tumour and nodal stage, smoking status and use of induction chemotherapy. Results Complete records for 725 patients were available, with 192 deaths and 145 failure events. Median follow-up duration for OS was 64 months (range 62 to 67 months) and for FFR was 50 months (range 47 to 53.4 months). 529 patients (73%) completed the scheduled two cycles of CDDP, 65 (9%) switched to carboplatin for cycle two and 131 (18%) did not receive a second cycle of chemotherapy. Reasons for omitting cycle two CDDP included: treatment side effects (n = 78), renal impairment (n = 75), hearing loss (n = 15), neutropenia (n = 12), cardiac toxicity (n = 5), anaemia (n = 2), peripheral neuropathy and allergic reaction (both n = 1). Compared to two cycles of CDDP, a single cycle and no further chemotherapy was associated with significantly reduced FFR (HR = 1.74, 95% CI 1.18-2.57, p=0.005; Figure 1a) and OS (HR = 1.65, 95% CI 1.16-2.35, p=0.005; Figure 1b) Switching from CDDP to carboplatin for cycle 2 was not associated with inferior FFR (HR = 1.10, 95% CI 0.614-1.96, p=0.753) or OS (HR = 1.2, 95% CI 0.72-2.01, p = 0.487). Conclusion Compared to completing two scheduled cycles of CDDP, omission of a second cycle of chemotherapy is associated with poor survival. Although not powered to confirm non-inferiority, our data suggest switching to a carboplatin-containing regimen for cycle two may attenuate detriment to outcome. This approach may be considered for patients due a second cycle of concurrent chemotherapy who remain fit but with specific contra-indications to CDDP.en
dc.language.isoenen
dc.titleThe effect of switching to carboplatin chemo-RT for cycle 2 in cisplatin-ineligible HNSCC patientsen
dc.typeMeetings and Proceedingsen
dc.contributor.departmentThe Christie NHS Foundation Trust, Department of Clinical Oncology, Manchesteren
dc.identifier.journalRadiotherapy and Oncologyen
dc.description.noteen]


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