KEY POINTS
- This single-centre retrospective study included 170 patients with locally advanced head and neck squamous cell carcinoma treated between 2012 and 2022 with definitive or postoperative chemoradiotherapy. 130 received weekly cisplatin and 40 received carboplatin-paclitaxel.
- Radiotherapy was conventionally fractionated IMRT-based treatment to a median 66.6 Gy (range 59.4–72 Gy) at 1.8 Gy/fraction. Concurrent treatment was weekly cisplatin 40 mg/m² or carboplatin AUC 1 plus paclitaxel 40 mg/m², generally for 5–6 cycles.
- Carboplatin-paclitaxel patients were systematically less fit: median age was 65.5 versus 60 years, 30% versus 6% had ECOG 2, and the alternative regimen was selected primarily for poor performance status, hearing impairment, or renal dysfunction. This baseline imbalance is central to interpreting the comparison.
- Median progression-free survival was 29 months with carboplatin-paclitaxel versus 37 months with cisplatin (HR 0.74, 95% CI 0.44–1.26; p=0.14). Median overall survival was 48 versus 82 months, respectively (HR 0.62, 95% CI 0.36–1.10; p=0.11), with no significant difference after multivariable adjustment.
- In the definitive setting, neither PFS nor OS differed significantly between regimens. In the postoperative subgroup, however, cisplatin was associated with better overall survival (HR 0.37, 95% CI 0.14–0.99; p=0.048), reinforcing cisplatin as the preferred regimen for eligible high-risk postoperative patients.
- Grade III–IV hematologic toxicity occurred in 25.4% with cisplatin versus 12.5% with carboplatin-paclitaxel (p=0.13). Grade ≥3 dysphagia (60.2% vs 53.8%), erythema (17.4% vs 17.5%), mucositis (9.8% vs 16.6%) and long-term feeding-tube dependence did not differ significantly.
CLINICAL TAKEAWAY
Weekly carboplatin AUC 1 plus paclitaxel 40 mg/m² appears to be a reasonable concurrent option when cisplatin genuinely cannot be given, particularly in definitive chemoradiotherapy. These retrospective data do not establish equivalence, and the numerically better survival plus postoperative subgroup signal support keeping cisplatin as the standard for eligible patients.