title: Altered-fractionated radiotherapy in locally advanced head and neck cancer.
abstract: OBJECTIVE
  To revisit the biologic rationale, the clinical methodology, the outcome and perspectives of altered fractionation in head and neck oncology.
  
  
  RESULTS
  Various prospective trials and meta-analyses clearly underline the major benefit patients with locally advanced disease draw from hyperfractionation and the need for an adequate selection of time-dose factors to optimize therapeutic index for accelerated regimens. In addition, the advent of high-precision techniques such as intensity-modulated radiation therapy is bound to favor the development of more intensive regimens of irradiation in the management of locally advanced head and neck squamous cell carcinomas.
  
  
  CONCLUSIONS
  Altered fractionation, both as stand-alone strategy or as part of approaches combining radiation to systemic treatments, is offering a lot of opportunities to the radiation oncologist. Its role is likely to gain ground in all high-risk patients not amenable to systemic treatments, or for whom the high toxicity of chemotherapy is not justified, in case, for instance, of intermediate-risk disease.
authors: Genolier Swiss Medical Network, Department of Radio-Oncology, Clinique de Genolier, Genolier, Switzerland. jbernier@genolier.net
authors: Jacques
authors: J
authors: Bernier
authors: Jean-Claude
authors: JC
authors: Horiot
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D002986:Clinical Trials as Topic; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome