Acute toxicity profile of concomitant chemoradiotherapy in head and neck cancers: A randomized controlled comparison of weekly versus triweekly cisplatin schedule

Background: The standard chemoradiotherapy (CRT) protocol in head and neck cancers (HNC) consists of three cycles of high dose cisplatin once every three weeks. However, because of significant toxicity and poor compliance of this regimen, with the assumption that more frequent administration of smaller doses of cisplatin during the RT course will minimize adverse effects without compromising treatment efficacy weekly cisplatin schedules were developed. This study aimed to evaluate and compare the acute toxicity profiles of these two concomitant CRT protocols in squamous cell carcinoma of the head and neck. Methods: For this purpose, 89 HNC patients who considered as CRT candidates, enrolled in this trial and randomly assigned in the two following groups. Fourty-seven patients to arm A (40 mg/m2 weekly cisplatin) and 42 patients to arm B (100mg/m2 triweekly cisplatin). According to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0, weekly assessment and grading of acute toxicities was done. Results: Our results did not show any statistically significant difference between the rate of treatment interruption and acute hematologic and non-hematologic toxicity profiles of the two schedules of cisplatin administration. Only there was a trend of more grade>3 mucositis in the weekly cisplatin arm, but this did not reach a statistical significance. Conclusions: In conclusion, weekly administration of cisplatin concomitant with radiotherapy has no advantage over every three-week schedule in terms of acute treatment toxicity; thus, it cannot be routinely recommended.