title: Hypofractionated, palliative radiotherapy for advanced head and neck cancer.
abstract: BACKGROUND
  A significant proportion of advanced stage head and neck cancer patients are incurable and have a limited life expectancy. This study reports a single institution experience with a hypofractionated radiotherapy regimen for palliation of loco-regionally advanced and incurable HNSCC.
  
  
  METHODS
  Between 2000 and 2005, 110 patients of unresectable HNSCC were treated with a palliative radiotherapy (40Gy in 16 fractions). Distressing symptoms were assessed before treatment. Patients with good objective regression with acceptable toxicity received further escalation of dose till 50Gy. We made three strata to compare symptomatic improvement namely percentage relief <50%, between 50-75% and >75% as compared to baseline.
  
  
  RESULTS
  Most common baseline distressing complaints were pain in 109 (99%) patients and dysphagia in 97 (88%) patients. Eleven patients (10%) had complete response (CR) and 80 (73%) patients had complete and partial response (PR). At completion of radiotherapy 26%, 57%, and 17% of patients had <50%, 50-75%, and >75% symptomatic relief, respectively. The overall PFS (defined as either complete disappearance of the disease or non-progression in the irradiated field) at 12 months was 55.1% (95% CI, 40.3%-69.9%). On multivariate analysis weight >50kg (p=0.049) and radiotherapy dose of more than 40Gy (p=0.012) were found to be significant for PFS. Acute and late reactions were acceptable.
  
  
  CONCLUSIONS
  The hypofractionated radiotherapy regimen evaluated is an effective treatment modality for sustained symptoms relief with good response rates and acceptable toxicity.
authors.affiliation: Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India. jaiprakash.agarwal@rediffmail.com
authors.forename: Jai Prakash
authors.initials: JP
authors.lastname: Agarwal
authors.forename: Bhushan
authors.initials: B
authors.lastname: Nemade
authors.forename: Vedang
authors.initials: V
authors.lastname: Murthy
authors.forename: Sarbani
authors.initials: S
authors.lastname: Ghosh-Laskar
authors.forename: Ashwini
authors.initials: A
authors.lastname: Budrukkar
authors.forename: Tejpal
authors.initials: T
authors.lastname: Gupta
authors.forename: Anil
authors.initials: A
authors.lastname: D'Cruz
authors.forename: Prathamesh
authors.initials: P
authors.lastname: Pai
authors.forename: Pankaj
authors.initials: P
authors.lastname: Chaturvedi
authors.forename: Ketayun
authors.initials: K
authors.lastname: Dinshaw
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy*; D016009:Chi-Square Distribution; D019583:Dose Fractionation, Radiation; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011379:Prognosis; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D016896:Treatment Outcome