Using Nomograms to Predict Patient Tolerance to High-Dose Cisplatin During Concurrent Chemoradiotherapy in Locoregionally Advanced Head and Neck Cancer.

Abstract

Background: Concurrent chemoradiotherapy (CCRT) with high-dose cisplatin is the standard treatment for locally advanced head and neck cancer (LA-HNC). However, some patients experience underdosing or severe side effects due to intolerance. That is, identifying patients who can tolerate high-dose cisplatin remains challenging.

Methods: This study aims to develop a prediction nomogram to identify patients tolerating high cumulative cisplatin dose (CCD ≥ 200 mg/m²) during CCRT. The collected data of 1020 patients who received cisplatin-based definitive CCRT between 2010 and 2019 in a Taiwanese medical center were retrospectively reviewed.

Results: A prediction model was developed using stepwise multivariable logistic regression and evaluated for accuracy. A nomogram was created to predict the likelihood of completing a CCD ≥ 200 mg/m², and its performance was assessed using various measures. The higher CCD group had better-experienced status and median body mass index than the lower CCD group (p < 0.001 for both comparisons). Univariate analysis identified several risk factors for high-dose cisplatin intolerance, including old age, tumor site, the nasopharynx, stage IV disease, Charlson Comorbidity Index (CCI) ≥ 3, and weekly cisplatin (p < 0.001 for all). Multivariate logistic regression analysis revealed that age, tumor site, stage IV disease, and hemoglobin level strongly predicted high-dose cisplatin intolerance. The nomogram showed good predictive accuracy with a Brier score of 0.18, C-index of 0.71, calibration curve slope of 0.95, and intercept of 0.2. Similar values were observed in the non-nasopharyngeal carcinoma subgroup.

Conclusions: Our nomogram model identified patients who can tolerate higher cisplatin doses, showing predictive accuracy after internal validation. Developed using pretreatment characteristics like age, clinical stage, tumor size, and hemoglobin level, it predicts tolerability for CCD ≥ 200 mg/m². This method helps select patients for high-dose cisplatin, enabling confident prescription of three-weekly or weekly dosing to improve survival outcomes. Further prospective research is needed for a comprehensive nomogram.