@David

This RO has a preference for this weekly protocol. He didn't suggest it was better, but did state it was easier on his patients. Of note he is a RO, not a MO (and he is not from my CCC, but gave us a great presentation):

WEEKLY CISPLATIN & RADIOTHERAPY
1. Chemo-radiotherapy for SCC Head and Neck Cancer
2. Treatment of advanced Nasopharyngeal Cancer, following 2 � 3 cycles of neo-adjuvant chemotherapy

NB. This protocol only for use in patients with good renal function and able to drink oral fluids

Drugs/Dosage: Starting on Day 1 of radiotherapy:
Cisplatin 40mg/m2 IV once weekly for 6 � 7 weeks
Radiotherapy: 2Gy/fraction, given daily on weekdays only over 6��7 weeks, to a total of 66-70Gy
RT must commence within 1 hour of the end of cisplatin infusion
Administration: 1 litre 0.9% Sodium Chloride + 20mmol KCl + 10mmol MgS04 IV over 2 hours
Mannitol 20% 100 ml IV over 15 minutes
Cisplatin in 1 litre 0.9% Sodium Chloride IV over 2 hours
1 litre 0.9% Sodium Chloride + 20mmol KCl + 10mmol MgS04 IV over 2 hours
500ml 0.9% Sodium Chloride IV or 500ml - 1 litre water orally over 1 hour
Frequency: one course only, consisting of 6 to 7 doses of concurrent weekly cisplatin
Main Toxicities: myelosuppression; alopecia (mild); neuropathy / ototoxicity;
nephrotoxicity; ovarian failure/infertility
Anti-emetics: Cisplatin - highly emetogenic (as poorly controlled nausea is a difficult problem in
this patient group, prescribe 2nd line anti-emetics for delayed nausea routinely with
Cycle 1)
Regular FBC once weekly pre-chemotherapy
Investigations: (N.B. see Haem Toxicity section for Hb requirements)
U&Es & LFTs once weekly pre-chemotherapy
Mg2+ and Ca2+ once weekly pre-chemotherapy
EDTA Prior to 1st cycle
Comments: If patient has any baseline hearing problems, carboplatin AUC 2 should be
substituted for cisplatin, administered as discussed below under Renal Impairment.
For patients on Cycle 1 whose EDTA is not yet available, Cockcroft & Gault may
be used to predict GFR. Cisplatin dose should be adjusted if necessary once EDTA
available. EDTA should only be repeated if the result is borderline at the start of
treatment or if there is a 30% change in serum creatinine.
Check electrolytes � additional supplementation of magnesium, calcium and
potassium may be required.
Weight should be recorded prior to and at the end of cisplatin treatment, and a strict
fluid balance chart should be maintained. An average urine output of at least
100ml/hr must be maintained throughout treatment, and cisplatin infusion should not
be commenced unless this urine output is achieved. If the urine output is inadequate,
the patient should be assessed and urine output increased by administering 500ml
Sodium Chloride 0.9% IV +/- furosemide 20 � 40mg. Furosemide 20 � 40mg po
may also be given if there is a positive fluid balance of 1.5 litres, a weight gain of
1.5kg or symptoms of fluid overload. The patient should be asked to drink 2 litres of
fluid in the 24hrs following treatment, and to contact the hospital if this is
impossible because of problems e.g. nausea and vomiting.
Dose Modifications
Haematological Neutrophils < 1.5 x 109/l Delay cisplatin for 1 week (RT to continue).
Toxicity: or Repeat count and, if within normal
Platelets < 100 x 109/l parameters, resume treatment at full dose.
Haemoglobin (Hb) needs to be maintained above 12g/dl throughout this treatment1.
If the Hb falls below this level, a blood transfusion needs to be arranged (treatment
may continue).
Renal Impairment: NB. Cisplatin is both eliminated primarily (> 90%) in the urine and is itself
nephrotoxic.
GFR (ml/min) Cisplatin Dose
>60 Give 100% dose
45 � 59 Give 75% dose
20 - 44 Cisplatin contra-indicated
Carboplatin AUC 2*, administered in 250ml 5%
Glucose over 30 minutes, may be substituted. It may
be given according to this protocol, with however no
requirement for pre- or post-hydration, nor fluid
balance/urine monitoring
< 20 Carboplatin contraindicated
Formula:
Dose = Target AUC x (25 + GFR)
Neurotoxicity: Grade 2: Reduce cisplatin dose to 30mg/m2
Grade 3 - 4: Discontinue cisplatin

References:
Al-Sarraf, M. et al, JCO (1998), Vol 16 (4): 1310 � 1317

Bachaud, J et al; International Journal Radiation Oncology Biology Physics (1996);
36 (5): 999 - 1004

Prosnitz, RG et al; Int J Radiat Oncol Biol Phys 2005; 61: 1087 � 1095