Comparison of toxicity profiles between weekly paclitaxel and weekly cisplatin in concurrent chemoradiotherapy for locally advanced laryngeal cancer

Background: Cisplatin and paclitaxel are both commonly used chemotherapeutic agents in the treatment of locally advanced laryngeal cancer, with cisplatin being the standard. However, the toxicity profiles of these agents vary significantly, impacting treatment tolerability and patient quality of life. This study compares the local and systemic toxicities of weekly paclitaxel versus weekly cisplatin, both administered concurrently with radiotherapy. Methods: Sixty patients with locally advanced laryngeal cancer were randomly assigned to two groups. Arm A (n=30) received weekly paclitaxel (30 mg/m²), and Arm B (n=30) received weekly cisplatin (40 mg/m²), both alongside radiotherapy (66 Gy in 33 fractions over 6.5 weeks). Toxicities were assessed weekly during treatment and at follow- up using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE), version 5.0. Local toxicities such as mucositis and skin reactions, as well as systemic toxicities including renal impairment, nausea, and hematological effects, were monitored. Results: Local toxicities were more prevalent in the paclitaxel group, with higher incidences of grade 2 mucositis (53.3%) and skin reactions (40.0%), though these differences were not statistically significant. In contrast, systemic toxicities, particularly renal toxicity and nausea, were more common in the cisplatin group. Grade 2 renal toxicity was observed in 13.3% of cisplatin-treated patients compared to 3.3% in the paclitaxel group. Nausea occurred in 33.3% of the cisplatin group compared to 10.0% in the paclitaxel group. Conclusion: Weekly paclitaxel demonstrated a more favorable systemic toxicity profile compared to cisplatin, with lower incidences of renal toxicity and nausea. Although paclitaxel was associated with slightly higher local toxicities, it may be a safer alternative for patients with pre-existing conditions that contraindicate cisplatin, such as renal dysfunction. These findings suggest that patient-specific factors should guide the choice of chemotherapeutic agents in concurrent chemoradiotherapy for laryngeal cancer.