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LETTER TO THE EDITOR
Year : 2016  |  Volume : 53  |  Issue : 1  |  Page : 141-142
 

Cisplatin based adjuvant chemoradiation following neoadjuvant chemotherapy and surgery in advanced oral cavity cancers: A deliverable regimen?


1 Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
2 Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India

Date of Web Publication28-Apr-2016

Correspondence Address:
A Joshi
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.180861

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How to cite this article:
Noronha V, Joshi A, Patil V, Dhumal S, Agarwal J P, Ghosh-Lashkar S, Prabhash K. Cisplatin based adjuvant chemoradiation following neoadjuvant chemotherapy and surgery in advanced oral cavity cancers: A deliverable regimen?. Indian J Cancer 2016;53:141-2

How to cite this URL:
Noronha V, Joshi A, Patil V, Dhumal S, Agarwal J P, Ghosh-Lashkar S, Prabhash K. Cisplatin based adjuvant chemoradiation following neoadjuvant chemotherapy and surgery in advanced oral cavity cancers: A deliverable regimen?. Indian J Cancer [serial online] 2016 [cited 2019 Dec 10];53:141-2. Available from: http://www.indianjcancer.com/text.asp?2016/53/1/141/180861


Sir,

Neoadjuvant chemotherapy (NACT), followed by surgery is an acceptable treatment modality in technically unresectable oral cancers.[1],[2] In our institute, we consider chemoradiation as the standard adjuvant therapy post induction chemotherapy and surgery. However delivery of radiation or cisplatin based chemoradiation is considered difficult after NACT.[3] Concurrent radiation with cetuximab is considered as a preferable regimen in locally advanced head and neck cancers after NACT. However, the use of cetuximab is limited in developing world.[4] Hence, we frequently use weekly cisplatin (30 mg/m 2) based chemoradiation in this setting in our institute and would like to present our experience with this treatment.

Over the last 5 years, we have delivered adjuvant radiation treatment in 37 patients at our institute. Of which 33 oral cavity patients received cisplatin based chemoradiation after NACT and surgery in our institute. The poor prognostic postoperative histopathological features like close margin were seen in 1 patient (3.0%), node positivity in 11 patients (33.3%), peri nodal extension in 10 patients (30.3%), perineural invasion in 2 patients (6.1%) and lymph vascular invasion in 1 patient (3.0%).

Thirty-one patients (94.0%) received treatment on cobalt 60 machine with conventional 2 field technique with the dose prescription been done at midline. 1 patient (3.0%) received radiation with three-dimensional conformal radiation therapy and 1 patient (93.0%) received radiation with intensity-modulated radiation therapy. The dose delivered per fraction was 2 Gy with treatment been done 5 days in a week. The median dose delivered was 60 Gy. 32 patients (97%) completed radiation therapy. 18 patients (54.5%) received 6 or more cycles of cisplatin, 9 patients (27.3%) received 5 cycles, 4 patients (12.1%) received 4 cycles while 3 or below cycles were received in 2 patients. In 6 patients receiving <5 cycles of chemotherapy, 4 had persistent renal dysfunction while 2 had persistent Grade 4 hyponatremia leading to stopping of chemotherapy. 9 patients receiving 5 cycles were due to logistical issues. The median cumulative dose of cisplatin delivered was 180 mg/m 2 (range: 210–60 mg/m 2). The other common toxicities seen were any grade mucositis in 25 patients (75.8%), dermatitis in 18 patients (55.5%) and hematological toxicity in 30 patients (90.9%). Common grade 3–4 toxicities seen were dermatitis in 7 patients (21.2%), anemia in 3 patients (9.1%), electrolyte imbalances in 9 patients (27.2%). The derangement in serum creatinine occurring over the course of NACT and Chemoradiation (CTRT) has been shown in [Figure 1]. These results are in concurrence with the results reported by our center and other Indian centers reporting on radical concurrent chemoradiation alone.[5],[6],[7]
Figure 1: The increment in serum creatinine as graded by CTCAE version 4.02 seen over the course of whole treatment. It can be appreciated that post C2 of neoadjuvant chemotherapy only 0.25% of patients had grade 3 serum creatinine increased; while at the end of CTRT 4% of patients had it

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We would conclude that weekly cisplatin based chemoradiation seems a feasible approach in Indian setting after NACT followed by surgery. However, it should be remembered that in our series majority patients have received 2 cycles of NACT and then had undergone surgery. While in majority western studies radical CTRT was administered after 4 cycles of NACT without doing surgical resection.

 
 » References Top

1.
Patil VM, Noronha V, Joshi A, Muddu VK, Gulia S, Bhosale B, et al. Induction chemotherapy in technically unresectable locally advanced oral cavity cancers: Does it make a difference? Indian J Cancer 2013;50:1-8.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Patil VM, Prabhash K, Noronha V, Joshi A, Muddu V, Dhumal S, et al. Neoadjuvant chemotherapy followed by surgery in very locally advanced technically unresectable oral cavity cancers. Oral Oncol 2014;50:1000-4.  Back to cited text no. 2
    
3.
Lefebvre JL, Pointreau Y, Rolland F, Alfonsi M, Baudoux A, Sire C, et al. Induction chemotherapy followed by either chemoradiotherapy or bioradiotherapy for larynx preservation: The TREMPLIN randomized phase II study. J Clin Oncol 2013;31:853-9.  Back to cited text no. 3
    
4.
Ignacio DN, Griffin JJ, Daniel MG, Serlemitsos-Day MT, Lombardo FA, Alleyne TA. An evaluation of treatment strategies for head and neck cancer in an African American population. West Indian Med J 2013;62:504-9.  Back to cited text no. 4
    
5.
Gupta T, Agarwal JP, Ghosh-Laskar S, Parikh PM, D'Cruz AK, Dinshaw KA. Radical radiotherapy with concurrent weekly cisplatin in loco-regionally advanced squamous cell carcinoma of the head and neck: A single-institution experience. Head Neck Oncol 2009;1:17.  Back to cited text no. 5
    
6.
Kumar S, Pandey M, Lal P, Rastogi N, Maria Das KJ, Dimri K. Concomitant boost radiotherapy with concurrent weekly cisplatin in advanced head and neck cancers: A phase II trial. Radiother Oncol 2005;75:186-92.  Back to cited text no. 6
    
7.
Rishi A, Ghoshal S, Verma R, Oinam AS, Patil VM, Mohinder R, et al. Comparison of concomitant boost radiotherapy against concurrent chemoradiation in locally advanced oropharyngeal cancers: A phase III randomised trial. Radiother Oncol 2013;107:317-24.  Back to cited text no. 7
    


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