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Title: Optimal cumulative dose of cisplatin for concurrent chemoradiotherapy among patients with non-metastatic nasopharyngeal carcinoma: A multicenter analysis in Thailand
Authors: Nuttapong Ngamphaiboon
Arunee Dechaphunkul
Jiraporn Setakornnukul
Tanadech Dechaphunkul
Rungarun Jiratrachu
Bhoom Suktitipat
Chuleeporn Jiarpinitnun
Poompis Pattaranutaporn
Pongwut Danchaivijitr
Faculty of Medicine, Ramathibodi Hospital, Mahidol University
Mahidol University
Faculty of Medicine, Siriraj Hospital, Mahidol University
Prince of Songkla University
Keywords: Biochemistry, Genetics and Molecular Biology;Medicine
Issue Date: 3-Jun-2020
Citation: BMC Cancer. Vol.20, No.1 (2020)
Abstract: © 2020 The Author(s). Background: Chemoradiotherapy (CRT) with high cumulative doses (CDs) of cisplatin has been considered the standard of care for non-metastatic nasopharyngeal carcinoma (NPC). However, given most patients' inability to tolerate high CDs due to cisplatin-related toxicities, the optimal CD of cisplatin during CRT remains undetermined. Methods: Patients with non-metastatic NPC who received CRT with cisplatin between 2007 and 2017 were identified through the Thai head and neck cancer multicenter database and then categorized according to cisplatin CD (mg/m2) received. All complications and cisplatin-related toxicities during CRT were recorded. Results: We identified 779 non-metastatic NPC patients receiving low (≤150; n = 97), intermediate (151-250; n = 411), and high (> 250; n = 271) CDs of cisplatin. Low CD patients had significantly lower mean actual radiation dose (p < 0.001) and more radiotherapy delay (p = 0.010), while intermediate CD patients had the least hospitalization (p < 0.001). Overall, 39.3% of the patients experienced cisplatin-related toxicity, which was associated with poor overall survival (OS) (p = 0.001). Acute kidney injury was observed in 7% in all patients, which was highest among low CD patients (15.5%; p = 0.002). Intermediate CD patients had significantly longer median OS than the low and high groups (64 vs. 49.8 vs. 53.2, respectively; p = 0.015). Univariate, but not multivariate, analysis showed that CD of cisplatin was significantly associated with OS. Conclusion: CD of cisplatin during CRT was not an independent prognostic factor for OS. An intermediate CD induced minimal toxicity without compromising survival and should be considered the optimal CD. Nonetheless, a randomized phase 3 study evaluating the optimal CD of cisplatin is warranted.
ISSN: 14712407
Appears in Collections:Scopus 2020

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