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Age-dependent hemato- and nephrotoxicity in patients with head and neck cancer receiving chemoradiotherapy with weekly cisplatin

Altersabhängige Hämato- und Nephrotoxizität bei Patienten mit Kopf-Hals-Tumoren unter Radiochemotherapie mit wöchentlicher Cisplatin-Gabe

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Abstract

Background and purpose

In cases of simultaneous chemoradiotherapy (CRT), early recognition of toxic side effects is important, as drug discontinuation may prevent further injury. It appears favorable to undertake further steps to investigate whether patient subgroups behave differently depending on their toxicity profile.

Methods

We retrospectively analyzed 125 consecutive patients with non-metastasized carcinoma of the head and neck who were treated with CRT (cisplatin 40 mg/m2 weekly) in 2013/2014. Patients were planned to receive six cycles of cisplatin. Statistical analyses were performed using the chi2 test, t-test, Kaplan–Meier method, and the log-rank test, as appropriate.

Results

Eighty-six patients did not reach the intended sixth cycle (68.8%; 60.0% of whom were ≥60 years, p < 0.05). Acute kidney injury (glomerular filtration rate <60 mL/min/1.73m2) was the most common reason for drug discontinuation (26.7%; 82.6% of whom were ≥60 years; p < 0.01), followed by leukopenia <3/nL (23.3%; 75% of whom were <60 years; p < 0.01) and infection (11.6%). Patients who underwent ≥5 cycles were associated with prolonged overall survival and metastasis-free survival after CRT (p < 0.02; median follow-up 24 months), especially patients <60 years.

Conclusion

Acute kidney injury was the most common side effect in patients ≥60 years, whereas leukopenia characteristically occurred significantly more often in younger patients. Discontinuing cisplatin during CRT was associated with a worse outcome, especially in patients <60 years.

Zusammenfassung

Hintergrund und Zielsetzung

Bei einer simultanen Radiochemotherapie (CRT) ist eine Früherkennung von toxischen Nebenwirkungen bedeutsam, um weiteren Organschäden vorzubeugen. Hierzu ist wichtig, zu eruieren, ob bestimmte Subgruppen von Patienten ein unterschiedliches Profil ihrer Toxizitäten aufweisen.

Methoden

Es erfolgte eine retrospektive Analyse von 125 konsekutiven Patienten mit nichtfernmetastasierten Kopf-Hals-Tumoren, welche eine CRT (Cisplatin 40 mg/m2 wöchentlich) im Jahr 2013/2014 erhalten hatten. Vorgesehen waren insgesamt 6 Zyklen Cisplatin. Zur statistischen Analyse wurden Chi2-Test, t-Test, Kaplan-Meier-Methode und Log-rank-Test verwendet.

Ergebnisse

Sechsundachtzig Patienten erreichten den geplanten 6. Zyklus nicht (68,8 %; 60,0 % davon ≥60 Jahre; p < 0,05). Ein akutes Nierenversagen (glomeruläre Filtrationsrate <60 ml/min/1,73m2) war der häufigste Grund für eine Unterbrechung der Cisplatin-Gaben (26,7 %; 82,6 % davon ≥60 Jahre; p < 0,01), gefolgt von Leukopenie <3/nl (23,3 %; 75 % davon <60 Jahre; p < 0,01) und Infekt (11,6 %). Patienten, welche ≥5 Zyklen erhielten, wiesen ein verlängertes Gesamt- und metastasenfreies Überleben nach CRT auf (p < 0,02; medianes Follow-up 24 Monate), besonders Patienten <60 Jahre.

Schlussfolgerung

Ein akutes Nierenversagen war die häufigste Nebenwirkung bei Patienten ≥60 Jahre, wohingegen eine Leukopenie charakteristischerweise häufiger bei jüngeren Patienten auftrat. Eine Unterbrechung der Cisplatin-Therapie war mit einem schlechteren Outcome vergesellschaftet, besonders bei Patienten <60 Jahren.

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Authors and Affiliations

  1. Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany

    Fabian Weykamp, Katharina Seidensaal, Stefan Rieken, Stephan Mende, Sebastian Adeberg, Jürgen Debus & Stefan Ezechiel Welte

  2. Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany

    Fabian Weykamp, Katharina Seidensaal, Stefan Rieken, Stephan Mende, Sebastian Adeberg, Jürgen Debus & Stefan Ezechiel Welte

  3. National Center for Tumor diseases (NCT), Heidelberg, Germany

    Fabian Weykamp, Katharina Seidensaal, Stefan Rieken, Stephan Mende, Sebastian Adeberg, Jürgen Debus & Stefan Ezechiel Welte

  4. Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany

    Jürgen Debus

  5. Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany

    Jürgen Debus

  6. German Cancer Consortium (DKTK), partner site Heidelberg, Heidelberg, Germany

    Jürgen Debus

  7. Hospital Pharmacy, Heidelberg University Hospital, Heidelberg, Germany

    Kim Green

  8. Department of Otorhinolaryngology, Heidelberg University Hospital, Heidelberg, Germany

    Karim Zaoui

  9. Department of Oral and Maxillofacial Surgery, Saarland University Medical Center, Homburg, Germany

    Kolja Freier

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  1. Fabian Weykamp
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Correspondence to Stefan Ezechiel Welte.

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Conflict of interest

F. Weykamp, K. Seidensaal, S. Rieken, K. Green, S. Mende, K. Zaoui, K. Freier, S. Adeberg, J. Debus, and S.E. Welte declare that they have no competing interests.

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Weykamp, F., Seidensaal, K., Rieken, S. et al. Age-dependent hemato- and nephrotoxicity in patients with head and neck cancer receiving chemoradiotherapy with weekly cisplatin. Strahlenther Onkol 196, 515–521 (2020). https://doi.org/10.1007/s00066-019-01550-6

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  • DOI: https://doi.org/10.1007/s00066-019-01550-6

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