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.