Radiotherapy With Cisplatin vs Carboplatin Paclitaxel for Head and Neck Squamous Cell Carcinoma.

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.