Criteria for eligibility to cisplatin in the curative treatment of head and neck cancer: Consensus opinion from a panel of experts

Abstract

Squamous-cell carcinoma of the head and neck (SCCHN) is an important problem in Brazil, where epidemiological and socioeconomic features often create barriers to the implementation of combined modalities with curative potential. Cisplatin improves the efficacy of radiotherapy in the adjuvant treatment of localized SCCHN and in the definitive therapy of locally advanced disease. However, the addition of high-dose cisplatin to radiotherapy increases treatment toxicity and is not always warranted. A panel of experts convened in Sao Paulo, Brazil, for discussions and recommendations regarding the use of high-dose cisplatin in combination with radiotherapy in SCCHN. In addition to discussing their professional experience, panel members used the current literature to provide evidence-based, practical recommendations regarding sociodemographic or medical criteria that may preclude safe administration of cisplatin. It is hoped that the application of these recommendations in clinical practice may improve therapeutic results in Brazil and other countries with similar health-care environments.

Introduction

With nearly 700 thousand new cases and400 thousand deaths per year, squamous-cell carcinoma of the head and neck (SCCHN) is more frequent in developing countries, and currently accounts for 5% of malignancies worldwide (Ferlay et al., 2015). Central and South America are characterized by high incidence rates for head and neck cancer (Perdomo et al., 2016). Such rates are especially high in Brazil, where oral cavity and larynx tumors combined represent the second most frequent tumor type among men, with slightly larger number of estimated new cases every year than lung cancer (Brasil. Ministério da saúde. Instituto Nacional de Câncer, 2018). Although scientific advances in SCCHN have been slower than those observed in other subspecialties of oncology, multidisciplinary management, organ preservation, the recognition of the biologic diversity of different types of SCCHN, and the advent of effective systemic therapies have all brought incremental improvements over the past two decades (Rischin et al., 2015). Moreover, the recognition of the role of chemotherapy, especially high-dose cisplatin, as an adjunct to radiotherapy in the treatment of patients with resectable and locally advanced disease has been an important milestone in SCCHN (Pignon et al., 2009). However, the addition of high-dose cisplatin to radiotherapy increases treatment toxicity and may not be warranted in some patients, and it has been suggested that only about half of the patients are able to receive the planned three cycles of high-dose cisplatin (Bernier et al., 2004). In addition to acute toxicity, such as nausea, vomiting, renal dysfunction, myelosuppression, transaminase and bilirubin elevation, hypersensitivity reactions and other less frequent events, the risk of long-term complications from the use of high-dose cisplatin should always be borne in mind. Such late toxicities are usually seen in patients treated with chemoradiation protocols, and include dysphagia, xerostomia, hypothyroidism, ototoxicity, and osteoradionecrosis (Rivelli et al., 2015).

Brazil is a country where socioeconomic features often create barriers to the widespread implementation of combined modalities with curative potential (Sanabria et al., 2010). Moreover, there is insufficient local data that may inform decisions about individual treatment modalities, especially systemic therapy (de Castro et al., 2007). Thus, in March 2017 a panel of experts convened in Sao Paulo, Brazil, to discuss and provide recommendations regarding the safe use of high-dose cisplatin in combination with radiotherapy in oral cavity, oro- and hypopharynx, and larynx squamous-cell carcinomas, here named as SCCHN. The results of that panel, presented in this paper, aim at informing health-care providers caring for patients with SCCHN in Brazil and in other countries with similar socioeconomic environments.