HEAD AND NECK Weekly cisplatin concurrently with radiotherapy in head and neck squamous cell cancer: a retrospective analysis of a tertiary institute experience Nemer Osman • Yasir Y. Elamin • Shereen Rafee • Cathal O’Brien • Leo F. A. Stassen • Conrad Timon • John Kinsella • Sinead Brennan • Kenneth J. O’Byrne Received: 12 August 2013 / Accepted: 27 September 2013 / Published online: 13 October 2013 Ó Springer-Verlag Berlin Heidelberg 2013 Abstract Radiotherapy combined with three weekly 100 mg/m 2 of cisplatin is the accepted standard of care in head and neck squamous cell carcinoma. However, this regimen is associated with severe toxicities with devastat- ing effects on patients. Alternative protocols like weekly 40 mg/m 2 have been used in an attempt to reduce toxici- ties. The main objective of the present study is to identify the dose intensities and toxicities of weekly cisplatin in patients treated in a tertiary centre over a 12 month period. Included patients had squamous cell carcinoma arising in the oral cavity, oropharynx, larynx, or hypopharynx. Patients were excluded if they had nasopharyngeal squa- mous cell carcinoma, distant metastasis or if they had prior treatment for head and neck cancer excluding neck dis- section. During the study period, 52 patients met the inclusion criteria and their data were retrospectively obtained from the patients’ database of St James hospital, Dublin. The median age of the study cohort was 54 years (range 33–73). Of the patients, 40 (76.9 %) were male and 12 (20.1 %) were female. The primary tumour sites were as follows: oral cavity and oropharynx in 38 (73 %), larynx in 10 (19 %), and hypopharynx in 4 (8 %). In total, 33 (63.5 %) patients had stage IV disease, while 19 (36.5 %) had stage III disease. Treatment was definitive in 35 (67 %) patients and adjuvant in 17 (35 %). Full-dose radiotherapy was achieved in 50 (96 %) patients. Only 22 (42.3 %) patients completed the intended six cycles of chemother- apy. Cumulative dose of 200 mg/m 2 or more was reached in 37 (71 %) patients. The acute adverse effects included grades 3 and 4 mucositis, which occurred in 22 (43.3 %) and 6 patients (12 %), respectively. Grade 3 and 4 neu- tropenia occurred in six (11.5 %) and three (5.7 %) patients, respectively. The only other haematological tox- icity was grade 3 anaemia in 20 (38.4 %) patients. There was no grade 3 or 4 renal toxicity among the study cohort, although grade 2 was observed in six (11.5 %) patients. Death occurred in one patient due to neutropenic septi- caemia. In conclusion, weekly cisplatin is associated with moderate to severe toxicities and might lead to suboptimal chemotherapy delivery. More prospective clinical studies are required to determine the optimal chemoradiation regimen in head and neck squamous cell carcinoma. Keywords Combined chemoradiotherapy Á Weekly cisplatin Á Acute toxicities Á Head and neck cancer Introduction Head and neck squamous cell carcinoma is the fifth com- monest cancer worldwide [1]. Clinically, head and neck cancer can be divided into three categories—early, locore- gionally advanced and metastatic [2]. While surgery and palliative chemotherapy is the mainstay of treatment of cancers in the early and metastatic categories, respectively, N. Osman (&) Á Y. Y. Elamin Á S. Rafee Á C. O’Brien Á L. F. A. Stassen Á C. Timon Á J. Kinsella Á S. Brennan Á K. J. O’Byrne Medical Oncology Department, St. James’s Hospital, Dublin, Ireland e-mail: nemerosman@yahoo.com L. F. A. Stassen Maxillo-Facial Department, St. James’s Hospital, Dublin, Ireland C. Timon Á J. Kinsella ENT Department, St. James’s Hospital, Dublin, Ireland S. Brennan St Luke’s Radiation Oncology Hospital, Dublin, Ireland 123 Eur Arch Otorhinolaryngol (2014) 271:2253–2259 DOI 10.1007/s00405-013-2749-9