目的：比較頭頸癌病患接受同步放射化學治療使用三週一次高劑量和每週一次低劑量順鉑之急 性反應與耐受度。 材料與方法：從 2014 年 10 月至 2015 年 12 月共有 61 位符合本研究條件之頭頸癌病患接受同步 放射化學治療，同步化療分為三週一次高劑量（100 mg/m2）順鉑（簡稱P100 Q3W組，31例） 或每週一次低劑量（30 mg/m2）順鉑（簡稱P30 QW組，30例），兩組接受一樣的強度調控放 射治療，針對靶區給予劑量 60-70 Gy/6-7 週，分析治療期間之急性反應、能給予的累積順鉑劑 量、平均順鉑劑量強度及放療總治療時間長短。 結果：兩組病人特徵皆類似，無統計顯著差異。P100 Q3W組病人有較高比例之三/ 四級白血球 低下（25.8% vs. 3.3%, p= 0.014），其他三/ 四級急性反應兩組相似，包含嗜中性球降低（16.1% vs. 3.3%, p= 0.095）、貧血（0% vs. 3.3%, p= 0.311）、血小板低下（0% vs. 0%, p= 1.000）、口腔 黏膜炎（35.5% vs. 23.3%, p= 0.300）和皮膚反應（0% vs. 10.0%, p= 0.073）。P100 Q3W組病人 也有較高比例之一/ 二級肌酸酐升高（41.9% vs. 16.7%, p= 0.032）。兩組病人平均接受累積順鉑 劑量為219.4 ± 47.7 mg/m2（P100 Q3W組）和80 ± 39.8 mg/m2（P30 QW組）（p= 0.001）。平均順 鉑劑量強度為30.9 ± 2.9 mg/m2/week（P100 Q3W組）和28.4 ± 2.6 mg/m2/week（P30 QW組）（p= 0.001）。完成放療所需平均時間，兩組沒有差異（50天vs.49天，p= 0.424）。 結論：頭頸癌病患接受同步放射化學治療時，採用三週一次高劑量順鉑比使用一週一次低劑量 順鉑，能給予較高順鉑累積總劑量，但也伴隨有較高三/ 四級以上白血球/ 嗜中性球低下和一/ 二 級肌酸酐升高副作用。

Purpose : To compare the acute toxicity and treatment compliance of tri-weekly highdose cisplatin with weekly low-dose cisplatin during concurrent chemoradiotherapy (CCRT) in head and neck cancer patients. Materials and Methods : From October 2014 to December 2015, a total of 61 head and neck cancer patients who had received CCRT were enrolled. All patients received intensity-modulated radiation therapy (IMRT) with 60-70 Gy in 6 to 7 weeks to the target region. Concurrent chemotherapy consisted of either tri-weekly cisplatin 100 mg/m2 (P100 Q3W, n= 31) or weekly cisplatin 30 mg/m2 (P30 QW, n= 30). The primary endpoint was acute toxicity during CCRT. The secondary endpoints were the accumulative cisplatin dose, cisplatin dose intensity, and overall treatment period of radiotherapy. Results : The baseline patient characteristics of both studies were similar between both arms. Patients who received P100 Q3W group had a higher rate of Gr 3/4 leucopenia (25.8% vs. 3.3%, p= 0.014) than those who received P30 QW. Other Gr 3/4 toxicities were similar in both arms, including neutropenia (16.1% vs. 3.3%, p= 0.095), anemia (0% vs. 3.3%, p= 0.311), thrombocytopenia (0% vs. 0%, p= 1.000), mucositis (35.5% vs. 23.3%, p= 0.300) and skin reaction (0% vs. 10.0%, p= 0.073). There was no Gr 3/4 serum creatinine elevation in either arm, however more mild grade (Gr 1/2) creatinine elevation was observed in patients who received P100 Q3W (41.9% vs. 16.7%, p= 0.032). The mean accumulative cisplatin dose delivery in the P100 Q3W group and the P30 QW group was 219.4 ± 47.7 mg/m2 and 181.0 ± 38.9 mg/m2 (p= 0.001), respectively. The mean dose intensity in P100 Q3W group was 30.9 ± 2.9 mg/m2/week, and 28.4 ± 2.6 mg/m2/week in the P30 QW group (p= 0.001). The mean overall treatment period of radiotherapy was similar in both groups (50.0 vs. 49.0 days, p= 0.424). Conclusion : The P100 Q3W schedule delivered a significantly higher accumulative cisplatin dose than the P30 QW, but had a higher incidence of severe leucopenia/ neutropenia along with a mild degree of serum creatinine elevation.