క్యాన్సర్ సైన్స్ & థెరపీ

Evaluation of Cisplatin Induced Toxicity in Head and Neck Cancer and Cervical Cancer During Concurrent Chemoradiotherapy. Experience of National Institute of Oncology in Morocco

Abstract

Maghous A, Marnouche E, Loughlimi H, Rais F, Benhmidou N, Adani-Ife N, Elmajjaoui S, Elkacemi H, Kebdani T and Benjaafar N

Background: Cisplatin is widely used as radio sensitizer in head and neck cancer (HNC) and cervical cancer. We conducted this prospective study to evaluate cisplatin induced toxicity as once-weekly regimen in HNC and cervical cancer during concurrent chemoradiotherapy (CCRT) to optimize its administration. Patients and methods: From 01 January 2015 to 11 May 2015, a data of all eligible patients treated by chemoradiation regimens containing a low dose of cisplatin were collected at the Department of radiotherapy in National Institute of Oncology in Morocco. Cisplatin was used weekly at 40 mg/m2 with adequate hydration and premedication in all patients. A complete blood count and renal function tests were done prior to each cycle of chemotherapy to evaluate toxicity according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE, version 4.0). Results: A total of 96 patients were eligible for the analysis. Mean age, PS, initial weight, enteral nutrition, cisplatin mean dose, use of oral Ondansetron and baseline serum tests did not differ significantly among the types of malignancy. However, weight loss was significantly noted among HNC group compared to cervical cancer patients with 6.06 ± 2.92 kg and 0.02 ± 0.13 kg respectively. Toxicity was observed only in 16 (20%) patients after the 4th week of treatment especially among HNC group. The neutropenia and thrombocytopenia were significantly greater for patients of HNC. However, we did not observe any renal toxicity, thrombocytopenia and ≥ grade 3 neutropenia toxicity in cervical cancer group. In multivariated analysis, only a subtype of HNC (OR, 1233; 95% CI, 16-95 103; P=0.001) and grade 2 emetogenicity (OR, 34.8; 95% CI, 2.1-583; P=0.014) were significantly associated with an increased risk for cisplatin toxicity. Whereas, less than 4 weekly cisplatin treatment (OR, 0.4; 95% CI, 0.1-0.9; P=0.046) was associated with a significantly reduced risk. Conclusion: Our data have revealed that individuals with HNC were at a significantly higher risk for cisplatininduced toxicity during CCRT and suggest that the once-weekly smaller dose of cisplatin regimen and conventional prophylactic procedures of administration might be effective for protection against the renal toxicity of cisplatin.