Comparison of Response to the Concurrent Low Dose Daily Cisplatin Vs Weekly Cisplatin Vs Three Weekly Cisplatin with External Beam Radiotherapy in Carcinoma Cervix Patients of Stage IIB, IIIA & IIIB: A Prospective Study from Single Institution

Introduction: Cervical cancer continues to be a major public health problem affecting middle-aged women, particularly in less-resourced countries. External beam radiation therapy along with intra cavitary insertion has long been the treatment of choice for locally advanced (IIB-IVA) cervical cancer, but long-term successes are limited in terms of pelvic recurrence or distant metastasis. Outcome of low dose daily versus weekly versus three weekly Cisplatin concurrent with External beam radiotherapy in locally advanced cervical carcinoma was compared in this study. Methods: A prospective cross sectional study was carried out in J K cancer institute, Kanpur. Total 60 patients of cervical cancer were randomized into 3 arms. Arm I, Arm II and Arm III received External beam radiotherapy concurrent with either daily (8mg/m2), weekly (40 mg/m2) or three weekly (100 mg/m2) Cisplatin respectively. External beam radiotherapy was given with a dose of 50 Gy / 25 # / 5 week / 2 field or 4 field. Patients were evaluated weekly during treatment and afterwards up to 1year. Results: Most of the patients were from fourth and fifth decade, low socioeconomic strata and illiterate. Majority of the cases belong to squamous cell carcinoma (96.6%) and stage III B (55%). Objective response in arm I was 80.0%, in arm II was 75.0% and in arm III was 60.0% respectively. Statistically significant difference was noted between arm III and Arm I (80%Vs60% p<0.05). Results were better in arm I as compare to arm II but not statistically significant. (80%Vs75% P>0.05) Conclusions: This study showed that response was better in ARM I as compared to ARM III and best results was seen with Cisplatin concurrent daily with radiation. Keywords: Cisplatin, concurrent chemotherapy, daily, weekly, three weekly, carcinoma cervix

COMPARISON OF COMPLIANCE AND RESPONSE FOR NEOADJUVANT CHEMOTHERAPY FOLLOWED BY CONCURRENT CHEMO RADIATION VERSUS CHEMO RADIATION ALONE IN CARCINOMA CERVIX FIGO STAGE IVA- A SINGLE INSTITUTION EXPERIENCE.

Aims/Objectives: Cervical cancer is the second most cancer in women in India. Patients presenting with stage IVa have 5 year survival rates of only 16% and are not able to complete the full course of radiation due to advance disease. The aim of this retrospective study is to study the compliance of the stage IVa patients to neoadjuvant chemotherapy (NACT) followed by concurrent chemo radiotherapy and their completion of radical dose of radiation and subjective response in comparison to patients without NACT. Materials and Methods: We retrospectively studied stage IVa cervical cancer patient's case sheets from January 2019 to June 2020. The patients are divided in to 2 arms: Arm-A : 11 patients - who received NACT with Paclitaxel 175mg/m2 and carboplatin AUC 6 every 3 weeks of 4 cycles followed by external beam radiotherapy(EBRT) of 50 Gy/25 fractions with weekly cisplatin of 40 mg/m2, followed by brachytherapy of 700cGy of 3 fractions. Arm-B: 9 patients-who received external beam radiotherapy (EBRT) of 50 Gy/25 fractions with weekly cisplatin of 40 mg/m2, followed by brachytherapy of 700cGy of 3 fractions. The compliance to complete radical dose of radiotherapy with concurrent chemotherapy and response in patients with and without NACT were compared Results: Arm A: 10 patients (91%) completed radical dose of RT and weekly cisplatin, one patient (9%) defaulted for EBRT, all patients tolerated 4 cycles of NACT. During 3 months follow up 1 patient (9%) developed liver secondaries and 1 patient (9%) developed other complication (jejunal obstruction) 2 patients suffered dysuria(18%) and 7 (64%) patients asymptomatic. Arm B: 4 patients (44.5%) completed radical dose of RT and 5 patients (55.5%) defaulted radiation [one for EBRT and 4 for HDR] During 3 months follow up one patient (11%) developed liver secondaries and 1(11%) developed uraemia and died (both these patients completed radical dose), 2 (22.2%) patients with dysuria,2 (22.2%) patients with bleeding p/v and 3(33.3%) patients are asymptomatic. Patients who defaulted for radical dose of concurrent RT were more in arm -B (55%) when compared to arm- A(9%) More patients are asymptomatic in arm-A(64%) than arm-B(33%). Conclusions: Response and compliance to treatment was better in the patients who received NACT followed by concurrent chemo radiation and are able complete treatment and majority of them are asymptomatic. From this it may be concluded that NACT may be considered in stage IVa cervical cancer. However a prospective trial with large number of patients is needed to come to a conclusion.

Treatment Outcomes of Head and Neck Cancer Patients in the Elderly Receiving Different Chemoradiation Combinations: A Single-Center Experience

<b><i>Objectives:</i></b> This study aimed to assess the effect of definitive or adjuvant concurrent chemoradiation (CRT) among elderly patients with locally advanced head and neck squamous cell carcinoma (LA HNSCC). <b><i>Materials and Methods:</i></b> We retrospectively analyzed 150 elderly LA HNSCC patients (age ≥70) at a single institution. Demographics, disease control outcomes, and toxicities with different chemotherapy regimens were reviewed. The Kaplan-Meier method was used to estimate progression-free survival (PFS) and overall survival (OS) estimates. <b><i>Results:</i></b> Median age at diagnosis was 74 years (range 70–88). Of the cohort, 98 (65.3%) patients received definitive and 52 (34.7%) received adjuvant CRT; 44 (29.3%) patients received weekly carboplatin and paclitaxel, 43 (28.7%) weekly cetuximab, 33 (22%) weekly carboplatin, and 30 (20%) weekly cisplatin. The OS at 2 years was 70% (95% confidence interval [CI]: 63–79%), and PFS at 2 years was 61% (95% CI: 53–70%). There was no significant difference in OS or PFS between definitive and adjuvant CRT (<i>p</i> = 0.867 and <i>p</i> = 0.475, respectively). Type of chemotherapy regimen (single-agent carboplatin vs. others) (95% CI: 1.1–3.9; <i>p</i> = 0.009) was a key prognostic factor in predicting OS in multivariable analysis. Concurrent use of cetuximab was associated with increased risk of PEG tube dependence at 6 months (<i>p</i> &#x3c; 0.001). <b><i>Conclusions:</i></b> Management of LA HNSCC in the elderly is a challenging scenario. Our study shows that CRT is a feasible treatment modality for elderly patients with LA HNSCC. We recommend CRT with weekly cisplatin or weekly carboplatin and paclitaxel. A chemotherapy regimen should be carefully selected in this difficult to treat population.

Comparative study on hemato- and nephrotoxicity profile of weekly versus every 3-weekly cisplatin dosage during induction chemotherapy in locally advanced head neck squamous cell carcinoma

Background Cisplatin is a frontline anticancer drug routinely used as part of concurrent chemoradiation administered at 3-weekly (100 mg/m2) dose. However, its role as fractionated weekly dose has achieved favorable outcome in patients with locally advanced squamous cell carcinoma of head and neck (LA-SCCHN) during induction chemotherapy (IC). We therefore sought to compare the toxicity outcomes of patients with LA-SCCHN treated with platinum-based IC at a single institution study using split-dose cisplatin chemotherapy. We compared the hematological and renal toxicity profile between the weekly cisplatin (30 mg/m2) (group A) versus 3-weekly (100 mg/m2) (group B) dosage schedule in this setting. Results The median age of the patients in groups A and B were 49.1 years and 48.27 years respectively with male:female ratio of 4:1. Most of the patients were of oropharyngeal cancers. Group A patients showed greater neutropenia (40.2%) than group B (20.6%). There was statistically significant fall in Hb% level in group A (13.9%) than in group B (11.9%). Renal profile showed greater rise in serum urea and serum creatinine (52.7%) in group B than in group A (52.29%) with statistically significant difference. Conclusions Since toxicities induced by high-dose cisplatin are irreversible and reduce quality of life in patients, the weekly regimen may be preferred owing to less renal toxicity, lesser hospitalization and more feasible in situations with high patient load and limited resources.