title: Altered fractionation radiotherapy in head and neck cancer: clinical issues and pitfalls of "evidence-based medicine".
abstract: The authors present a critical appraisal of the biological bases of altered fractionation and a brief overview of published randomized trials with conventional fractionation as the control arm, reviews and meta-analysis on altered fractionation radiotherapy in head and neck cancer. The major controversial issues emerging from these studies are reviewed and the limiting factors which so far have prevented the widespread use of altered fractionation regimens in current clinical practice are analyzed. Future perspectives regarding predictive biological assays for patient selection and the integration of altered fractionation regimens with radiochemotherapy protocols, biomodulators and novel radiotherapy techniques are also reviewed and summarized.
authors.affiliation: Servizio di Radioterapia, CdC Santa Maria-Multimedica Hospitals, Castellanza, VA, Italy. p.antognoni@libero.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Antognoni
authors.forename: Renzo
authors.initials: R
authors.lastname: Corvò
authors.forename: Dario
authors.initials: D
authors.lastname: Zerini
authors.forename: Roberto
authors.initials: R
authors.lastname: Orecchia
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D017326:Clinical Trials, Phase III as Topic; D019583:Dose Fractionation, Radiation; D019317:Evidence-Based Medicine; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D015201:Meta-Analysis as Topic; D011878:Radiotherapy / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic