Hypofractionated, palliative radiotherapy for advanced head and neck cancer.
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.
Agarwal
Jai Prakash
JP
Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India. jaiprakash.agarwal@rediffmail.com
Nemade
Bhushan
B
Murthy
Vedang
V
Ghosh-Laskar
Sarbani
S
Budrukkar
Ashwini
A
Gupta
Tejpal
T
D'Cruz
Anil
A
Pai
Prathamesh
P
Chaturvedi
Pankaj
P
Dinshaw
Ketayun
K
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