title: Split-Course Accelerated Hypofractionated Radiotherapy (SCAHRT): A Safe and Effective Option for Head and Neck Cancer in the Elderly or Infirm.
abstract: BACKGROUND
  Achieving locoregional control in high-risk patients with head and neck cancer who are poor candidates for standard continuous-course (chemo) radiotherapy due to advanced age, comorbidities, or very advanced disease is challenging. At our Institution, we have significant experience with a regimen of split-course, accelerated, hypofractionated radiotherapy (SCAHRT) for these patients.
  
  
  METHODS
  The SCAHRT regimen consisted of 60-72 Gy in 20-24 fractions separated by several weeks mid-course to allow for toxicity recovery and disease reassessment. It was used for patients with advanced age, significant co-morbidities, anticipated intolerance to definitive (chemo)radiation, and those with oligometastatic disease. Disease-free and overall survival rates were calculated using Kaplan-Meier analysis.
  
  
  RESULTS
  Fifty-eight out of 65 patients (89%) completed both courses of treatment. Patients without metastatic or recurrent disease were evaluated for treatment response and survival (n=39). Among this group, total tumor response was 91%, and median locoregional failure-free survival and overall survival were 25.7 and 8.9 months, respectively.
  
  
  CONCLUSIONS
  In high-risk patients unable to tolerate continuous-course definitive (chemo)radiation, SCAHRT is a safe, well-tolerated and effective method of achieving durable locoregional disease control. In properly selected patients, this regimen is preferable to purely palliative approaches.
authors.affiliation: Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, U.S.A.
authors.forename: Trevor J
authors.initials: TJ
authors.lastname: Bledsoe
authors.affiliation: Case Western Reserve University, School of Medicine, Cleveland, OH, U.S.A.
authors.forename: Anisha R
authors.initials: AR
authors.lastname: Noble
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland, OH, U.S.A.
authors.forename: Chandana A
authors.initials: CA
authors.lastname: Reddy
authors.affiliation: Department of Otolaryngology and Head and Neck Surgery, Cleveland Clinic, Cleveland, OH, U.S.A.
authors.forename: Brian B
authors.initials: BB
authors.lastname: Burkey
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland, OH, U.S.A.
authors.forename: John F
authors.initials: JF
authors.lastname: Greskovich
authors.affiliation: Department of Solid Tumor Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A.
authors.forename: Tobenna
authors.initials: T
authors.lastname: Nwizu
authors.affiliation: Department of Solid Tumor Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A.
authors.forename: David J
authors.initials: DJ
authors.lastname: Adelstein
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland, OH, U.S.A.
authors.forename: Jerrold P
authors.initials: JP
authors.lastname: Saxton
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland, OH, U.S.A. koyfmas@ccf.org.
authors.forename: Shlomo A
authors.initials: SA
authors.lastname: Koyfman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000069473:Radiation Dose Hypofractionation; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Head and neck cancer; elderly; hypofractionated; radiotherapy; split course