Tata-tata-ta.

Chemoradiation is superior to radiation alone for patients with intact locally advanced or high-risk resected head and neck cancer. By “chemoradiation” we mean high-dose cisplatin given every three weeks during radiation therapy. This is pretty toxic, so many patients receive divided cisplatin doses every week to improve tolerability with a questionable compromise in tumor control. Now there’s no question. A prospective randomized noninferiority trial from Tata Memorial Center directly compares weekly (at 30 mg/m2) versus every three-weekly (at 100 mg/m2) cisplatin in 300 patients receiving (mostly adjuvant) chemoradiation for (mostly) oral cavity cancer. The big reveal: locoregional control at 2 years was significantly worse with low-dose weekly (59%) compared to high-dose three-weekly (73%) cisplatin. There was a lot of severe toxicity overall, but as expected it was higher with high-dose three-weekly cisplatin (85% vs 72%)—which was also associated with more hospitalizations (31% vs 13%)—though the rate of feeding tubes was similar (~65%). So...tata!  Weekly cisplatin concurrent to radiation for H&N cancer has officially failed to prove non-inferiority for locoregional control in the (mostly) adjuvant setting, which adds concern to skepticism over recent practice patterns.