Journal Reading:

A comparison of weekly versus 3-weekly

cisplatin
during adjuvant radiotherapy for high-risk head
and neck cancer
Disusun Oleh:
Yeni Notanubun 102012435 UKRIDA
Fathinah Zuhudan R. 1102013107 YARSI
 ABSTRAK
To compare cumulative cisplatin dose & toxicity
between patients who:
OBJEKTIF received 3-weekly VS weekly cisplatin
during adjuvant radiotherapy for high-risk head &
neck squamous cell carcinoma (HNSCC)

HNSCC patients w/ involved resection margins

and/or extracapsular extension in 2 tertiary cancer
centers w/ different institutional practices
Calculated cumulative cisplatin dose & Information
METODE on toxicity reviewed
Compared between patients who received 3-weekly
VS weekly cisplatin
 ABSTRAK

270 high risk patients:

60 3-weekly 100 mg/m2
48 weekly 50 mg/m2 cisplatin during
adjuvant radiotherapy (6066 Gy in 3033
fractions).

HASIL 14 other chemotherapy schedules

148 no chemotherapy.

Mean cumulative cisplatin dose:

199.4 mg/m2 (SE 5.4) in 3-weekly
239.8 mg/m2 (SE 11.0, P = 0.001) in weekly
 ABSTRAK

Cumulative cisplatin >200 mg/m2 was given to:

67.7% of patients in 3-weekly cohort
85.2% (P = 0.039) in the weekly cohort.
HASIL
The rate of feeding tube dependency 6 months
after treatment, osteoradionecrosis, neutropenic
fever, & persistent renal function decline were not
statistically different.
 ABSTRAK

About one half of high-risk HNSCC patients are not

eligible for cisplatin during postoperative
radiotherapy.
Patients treated w/ weekly 50 mg/m2 cisplatin
KESIMPULAN received a higher cumulative dose w/ comparable
toxicity as patients who received 3-weekly 100
mg/m2 cisplatin.
Efficacy & applicability to the frequently used
weekly 40 mg/m2 schedule remains to be evaluated
PENDAHULUAN

Patients HNSCC treated w/

primary surgery
have a very high risk of The combination of adjuvant
recurrence radiotherapy & high dose
IF resection margins (+) &/ cisplatin
IF there is extra-capsular induces significant acute &
extension of lymph node long term toxicity [1,2].
metastases.
3 studies demonstrated
that these patients derive
benefit from adding high
dose cisplatin [13].
PENDAHULUAN

However, weekly
and 3- weekly As an alternative, a weekly lower
cisplatin plus dose cisplatin schedule has been
radiotherapy have used, based on the assumption that
not been compared a weekly regimen is less toxic and
directly in a equally effective as 3-weekly high
randomized and dose cisplatin
adequately
powered study
TUJUAN

Aimed to compare:
1. Patient cohorts from 2 tertiary care centers
where one center routinely treats high-risk HNSCC patients postoperatively
with 3-weekly high dose cisplatin
and the other center routinely gives weekly cisplatin.

If weekly cisplatin is better tolerated than 3-weekly cisplatin,

this might be reflected by a higher cumulative cisplatin dose in patients
treated with a weekly schedule.
2. The cumulative cisplatin dose & toxicity between patients treated with a
weekly schedule & patients treated with the high dose 3-weekly schedule.
METODE

Retrospective cohort study

All consecutive patients w/ HNSCC who underwent
Study design, primary surgery & had (+) resection margins (<1mm)
patients, & &/ extra-capsular extension of lymph node
treatment metastasis stared adjuvant radiotherapy
01/03/2005 12/12/12 at PM & 15/12/2008
15/07/2013 at UMCG institutional database &
patient rec.
METODE

Study design,
patients, &
treatment
METODE

Study endpoints
& data analyses
HASIL
HASIL
 HASIL
Chemo-
Radiotherapy
Comparison Cohort
 HASIL
Chemo-
Radiotherapy
Comparison Cohort
 HASIL
Chemo-
Radiotherapy
Comparison Cohort
 HASIL The mean cumulative cisplatin dose was
Cumulative higher in patients treated with weekly
Cisplatin cisplatin (239.8 mg/m2 , standard error
Dose (SE) 11.0)
Also the percentage of patients who
received a cumulative cisplatin dose
>200 mg/m2 was higher in the weekly
cohort (85.2%)
There was no significant interaction
between RT dose schedule, cisplatin
regimen, and the cumulative mean
cisplatin dose (p = 0.34)
 HASIL
Treatment
Morbidity
 HASIL
Recurrance
Rate
DISKUSI
KESIMPULAN

This retrospective comparison has demonstrated that

around one half of high-risk HNSCC patients are not eligible
for cisplatin during postoperative radiotherapy.
Weekly 50 mg/m2 cisplatin permits a higher cumulative
dose to be delivered with no evidence of excess toxicity
compared to 3-weekly 100 mg/m2 cisplatin during
postoperative radiotherapy.
Efficacy remains to be determined and it is unclear if this
data is applicable to the 40 mg/m2 weekly cisplatin
schedule, which is a commonly used alternative to high
dose 3-weekly cisplatin.6
TERIMAKASIH
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