Marin Abousaud, Saagar Pamulapati, Saad Rashid, Fabiola Lozano, Madeline Shepherd, Busola Fowowe, Yichun Cao, Pauline Kim, Yuan Liu, James E Bates, Mark McDonald, Soumon Rudra, William A Stokes, Jennifer Gross, Nicole C Schmitt, Mark W El-Deiry, Mihir R Patel, Anthea L Hammond, Yong Teng, Conor Steuer, Dong M Shin, Nabil F Saba
{"title":"Radiotherapy With Cisplatin vs Carboplatin Paclitaxel for Head and Neck Squamous Cell Carcinoma.","authors":"Marin Abousaud, Saagar Pamulapati, Saad Rashid, Fabiola Lozano, Madeline Shepherd, Busola Fowowe, Yichun Cao, Pauline Kim, Yuan Liu, James E Bates, Mark McDonald, Soumon Rudra, William A Stokes, Jennifer Gross, Nicole C Schmitt, Mark W El-Deiry, Mihir R Patel, Anthea L Hammond, Yong Teng, Conor Steuer, Dong M Shin, Nabil F Saba","doi":"10.1001/jamaoto.2025.1706","DOIUrl":null,"url":null,"abstract":"<p><strong>Importance: </strong>Despite the widespread use of carboplatin/paclitaxel (C/P) in concurrence with radiotherapy for patients with squamous cell carcinoma of the head and neck (SCCHN) who are ineligible to receive cisplatin, there is a lack of prospective or comparative analyses examining C/P vs cisplatin.</p><p><strong>Objective: </strong>To examine the clinical outcomes of patients with SCCHN receiving C/P vs cisplatin in concurrence with radiotherapy in the definitive and postoperative setting.</p><p><strong>Design, setting, and participants: </strong>This retrospective, single-center comparative effectiveness study included patients with SCCHN who received concurrent chemoradiotherapy with C/P or cisplatin from January 2010 to March 2021. Patients with human papillomavirus-related and unrelated disease were included. Data analysis was conducted in March 2022.</p><p><strong>Exposures: </strong>Patients received C/P or cisplatin. Most cisplatin patients received weekly cisplatin or C/P. Intensity-modulated radiotherapy was primarily used, with a median (range) total dose of 70 (66-70) Gy.</p><p><strong>Main outcomes and measures: </strong>Key efficacy end points were locoregional recurrence-free survival (LRFS), progression-free survival (PFS), distant metastasis-free survival (DMFS), overall survival (OS), and safety.</p><p><strong>Results: </strong>A total of 308 patients were included (66 female individuals [21.4%]; 60 African American individuals [19.5%], 9 Asian individuals [2.9%], 3 Hispanic individuals [1.0%], and 235 White individuals [76.3%]; median [range] age, 63 [24-89] years). Of these patients, 116 (37.7%) had never smoked, 117 (38.0%) formerly smoked, and 75 (24.4%) were active smokers. Primary sites were oropharynx (164 [53.2%]; 164 [84.7%] were human papillomavirus-positive), oral cavity (57 [18.5%]), and larynx (52 [16.9%]); a comparison of illness stage was T3/T4 (191 [62.0%]) vs T1/T2 (117 [38.0%]) and N1 to N3 (258 [83.8%]) vs N0 (50 [16.2%]). A total of 97 patients (31.5%) underwent surgery before concurrent therapy. No meaningful differences between cisplatin and C/P were observed for 3-year rates of LRFS (97.0% vs 96.2%; difference, -0.8%; 95% CI, -5.2% to 3.6%), PFS (77.5% vs 79.8%; difference, 2.3%; 95% CI, -7.4% to 12.0%), DMFS (83.4% vs 86.8%; difference, 3.4%; 95% CI, -5.3% to 12.1%), or OS (90.8% vs 92.9%; difference, 2.1%; 95% CI, -4.5% to 8.7%). C/P was associated with a higher rate of grade 3 to 4 leukopenia, anemia, and dermatitis and more feeding tube placements and hospitalizations.</p><p><strong>Conclusions and relevance: </strong>The results of this study suggest that there were no differences in LRFS, PFS, DMFS, and OS in patients with SCCHN receiving radiotherapy with C/P vs cisplatin. These results support the use of C/P as an alternative regimen in patients who cannot receive cisplatin.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"769-776"},"PeriodicalIF":5.6000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12203394/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JAMA otolaryngology-- head & neck surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1001/jamaoto.2025.1706","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Importance: Despite the widespread use of carboplatin/paclitaxel (C/P) in concurrence with radiotherapy for patients with squamous cell carcinoma of the head and neck (SCCHN) who are ineligible to receive cisplatin, there is a lack of prospective or comparative analyses examining C/P vs cisplatin.
Objective: To examine the clinical outcomes of patients with SCCHN receiving C/P vs cisplatin in concurrence with radiotherapy in the definitive and postoperative setting.
Design, setting, and participants: This retrospective, single-center comparative effectiveness study included patients with SCCHN who received concurrent chemoradiotherapy with C/P or cisplatin from January 2010 to March 2021. Patients with human papillomavirus-related and unrelated disease were included. Data analysis was conducted in March 2022.
Exposures: Patients received C/P or cisplatin. Most cisplatin patients received weekly cisplatin or C/P. Intensity-modulated radiotherapy was primarily used, with a median (range) total dose of 70 (66-70) Gy.
Main outcomes and measures: Key efficacy end points were locoregional recurrence-free survival (LRFS), progression-free survival (PFS), distant metastasis-free survival (DMFS), overall survival (OS), and safety.
Results: A total of 308 patients were included (66 female individuals [21.4%]; 60 African American individuals [19.5%], 9 Asian individuals [2.9%], 3 Hispanic individuals [1.0%], and 235 White individuals [76.3%]; median [range] age, 63 [24-89] years). Of these patients, 116 (37.7%) had never smoked, 117 (38.0%) formerly smoked, and 75 (24.4%) were active smokers. Primary sites were oropharynx (164 [53.2%]; 164 [84.7%] were human papillomavirus-positive), oral cavity (57 [18.5%]), and larynx (52 [16.9%]); a comparison of illness stage was T3/T4 (191 [62.0%]) vs T1/T2 (117 [38.0%]) and N1 to N3 (258 [83.8%]) vs N0 (50 [16.2%]). A total of 97 patients (31.5%) underwent surgery before concurrent therapy. No meaningful differences between cisplatin and C/P were observed for 3-year rates of LRFS (97.0% vs 96.2%; difference, -0.8%; 95% CI, -5.2% to 3.6%), PFS (77.5% vs 79.8%; difference, 2.3%; 95% CI, -7.4% to 12.0%), DMFS (83.4% vs 86.8%; difference, 3.4%; 95% CI, -5.3% to 12.1%), or OS (90.8% vs 92.9%; difference, 2.1%; 95% CI, -4.5% to 8.7%). C/P was associated with a higher rate of grade 3 to 4 leukopenia, anemia, and dermatitis and more feeding tube placements and hospitalizations.
Conclusions and relevance: The results of this study suggest that there were no differences in LRFS, PFS, DMFS, and OS in patients with SCCHN receiving radiotherapy with C/P vs cisplatin. These results support the use of C/P as an alternative regimen in patients who cannot receive cisplatin.
期刊介绍:
JAMA Otolaryngology–Head & Neck Surgery is a globally recognized and peer-reviewed medical journal dedicated to providing up-to-date information on diseases affecting the head and neck. It originated in 1925 as Archives of Otolaryngology and currently serves as the official publication for the American Head and Neck Society. As part of the prestigious JAMA Network, a collection of reputable general medical and specialty publications, it ensures the highest standards of research and expertise. Physicians and scientists worldwide rely on JAMA Otolaryngology–Head & Neck Surgery for invaluable insights in this specialized field.