Session Item

High-dose cisplatin (100 mg/m²) is considered the standard systemic regimen given concurrently with postoperative or definitive radiotherapy in locally advanced head and neck cancer. This chemoradiation regimen (CRT) is associated with 34,2% of acute kidney injury (AKI) of all grades with an impact on treatment intensity and ultimately survival. The objectives of this study were to investigate the impact of our institutional one-week at-home hydration protocol after each administration of cisplatin on tolerance and treatment dose intensity.

We collected data from all patients with locally advanced head and neck cancer (all histological types) treated with at least one cycle of cisplatin 100 mg/m² concomitantly with radiotherapy at Gustave Roussy between January 2015 and December 2020. Our institutional protocol for cisplatin 100 mg/m² every 3 weeks includes a hospital stay during which the patient receives an infusion of Bionolyte G5 3L/12h before and 2L/6h after the infusion of cisplatin for 3h. The External Care Coordination Service (CSE) organise at home after each cycle of cisplatin, the administration of 1 L of 0.9% saline solution for 12 h during the night for one week, leaving patients available for medical appointments during the day. Furthermore, remote monitoring by coordinating nurses from CSE has been set up to establish the link between hospital and home: patient-home nurses-doctors. 

494 head and neck cancer patients were analyzed ; 381 (77%) were men, 470 (95%) aged < 70 years, 97 (20%) had hypertension and 9 (0,2%) diabetes. 332 patients (67%) were smokers and 208 (42%) had a current use of alcohol. Before CRT, 73 (14%) patients had previously received induction chemotherapy and 127 (25%) had undergone surgery. 451 patients (91%) received ≥ 200 mg/m² and 242 (49%) completed the 300 mg/m² dose. The mean cumulative dose of cisplatin during CRT was 249.3 mg/m². 49 patients (9%) had creatinine clearance less than 60 ml/min, 17 (3%) had AKI grade 3 needing medical intervention. No grade 4 or 5 toxicities were reported. 252 patients required cisplatin dose reduction: 40 patients (8%) due to AKI, 64 patients (12%) due to severe mucositis/vomiting, 56 patients (11%) due to myelosuppression.

This is a retrospective study of real-world data over a long period of 5 years addressing a dual issue of tolerance and treatment intensity in head and neck cancer patients. The study showed that the proportion of patients developing AKI after cisplatin-based CRT and one week of hydration of only 9% is lower than data found in the literature. The proportion of patients receiving more than 200 mg/m² is relatively high in our daily practice. This strategy seems to be a cost efficient and very safe method to decrease AKI and optimize the dose intensity of CRT. Home based post-cisplatin hydration could be included in the standard management of head and neck cancer patients receiving concomitant CRT.