Feasibility and efficacy of subcutaneous amifostine therapy in patients with head and neck cancer treated with curative accelerated concomitant-boost radiation therapy.

Abstract

OBJECTIVE:

To assess the feasibility and efficacy of subcutaneous amifostine therapy in patients with head and neck cancer treated with curative accelerated radiotherapy (RT).

DESIGN:

Retrospective study.

SETTING:

University of Lausanne, Lausanne, Switzerland.

PATIENTS:

Thirty-three consecutive patients (male-female ratio, 4.5; median age, 54 years [age range, 39-76 years]).

INTERVENTIONS:

Between November 2000 and January 2003, the 33 patients were treated with curative definitive (n = 19) or postoperative (n = 14) RT with (n = 26) or without (n = 7) chemotherapy. All patients received conformal RT. Fractionation schedule consisted of concomitant-boost (Friday afternoon session) accelerated RT using 70 Gy (2 Gy per fraction) in 6 weeks in patients treated with definitive RT and 66 Gy (2 Gy per fraction) in 5 weeks and 3 days in the postoperative setting. Parotid glands received at least 50 Gy in all patients. Amifostine was administered to a total dose of 500 mg subcutaneously, 15 to 30 minutes before morning RT sessions.

RESULTS:

All patients received their planned treatment (including chemotherapy). Ten patients received the full schedule of amifostine (at least 25 injections), 9 received 20 to 24 doses, 4 received 10 to 19 doses, 5 received 5 to 9 doses, and 5 received fewer than 5 doses. Fifteen patients (45%) did not show any intolerance related to amifostine use. Amifostine therapy was discontinued because of nausea in 11 patients (33%) and hypotension in 6 patients (18%), and 1 patient refused treatment. No grade 3, amifostine-related, cutaneous toxic effects were observed. Radiotherapy-induced grade 3 acute toxic effects included mucositis in 14 patients (42%), erythema in 14 patients (42%), and dysphagia in 13 patients (39%). Late toxic effects included grade 2 or more xerostomia in 17 patients (51%) and fibrosis in 3 patients (9%). Grade 2 or more xerostomia was observed in 8 (42%) of 19 patients receiving 20 injections or more vs 9 (64%) of 14 patients receiving fewer than 20 injections (P = .15).

CONCLUSIONS:

Subcutaneous amifostine administration in combination with accelerated concomitant-boost RT with or without chemotherapy is feasible. The major adverse effect of subcutaneous administration was nausea despite prophylactic antiemetic medication, and hypotension was observed in only 6 patients (18%).

• Authors: Mahmut Ozsahin, Michael Betz, Oscar Matzinger, Luc Bron, François Luthi, Philippe Pasche, David Azria, René O Mirimanoff, Abderrahim Zouhair
• Journal: Archives of otolaryngology--head & neck surgery (Arch Otolaryngol Head Neck Surg) Vol. 132 Issue 2 Pg. 141-5 (Feb 2006) ISSN: 0886-4470 [Print] United States
• PMID: 16490870 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Radiation-Protective Agents
• Amifostine

Topics

• Adult
• Aged
• Amifostine (administration & dosage, therapeutic use)
• Dose Fractionation, Radiation
• Dose-Response Relationship, Radiation
• Feasibility Studies
• Female
• Follow-Up Studies
• Head and Neck Neoplasms (drug therapy, radiotherapy)
• Humans
• Injections, Subcutaneous
• Male
• Middle Aged
• Radiation Injuries (prevention & control)
• Radiation-Protective Agents (administration & dosage, therapeutic use)
• Radiotherapy, Adjuvant (methods)
• Retrospective Studies
• Treatment Outcome