Side Effects of Amifostine with Concurrent Chemoradiation Therapy for Head and Neck Cancer

Objective: Toxicity to normal tissues remains a major treatment-limiting factor in concurrent chemoradiation therapy (CCRT). This study was conducted to evaluate the toxicity of amifostine used along with CCRT to treat head and neck cancer. Patients and Methods: The medical records of 16 patients with head and neck cancer treated from June 2001 to November 2003 with CCRT plus amifostine in our department were retrospectively analyzed. The primary tumor was in the nasopharynx in 6, oropharynx in 6, and oral cavity in 4. Radiotherapy (RT) was administered to the primary tumor and regional lymph nodes at a dose of 64.8 to 72Gy over 7 to 8 weeks. Chemotherapy consisted of 6 weekly doses of cisplatin (30 mg/m^2) given approximately 1 hour prior to RT. A rapid 3-minute intravenous infusion of amifostine, 300 mg/m^2, was given 15 minutes before each RT fraction. All patients were examined at the end of each week. Adverse effects of amifostine were recorded. Results: In 8 of the 16 patients (50%), the amifostine therapy had to be discontinued or reduced because of amifostine-related toxicity. The dose was reduced to 210 mg/m^2 in 5 patients and stopped completely in another 3. Amifostine-related adverse effects resulted in delay of RT by 2 to 7 days in 7 of the 16 patients, and RT could not be completed in 1 patient. Long-term amifostine-related toxicity was not observed.