title: Altered fractionation radiotherapy in head and neck squamous cell carcinoma.
abstract: BACKGROUND
  Fractionation plays a pivotal role in determining the effectiveness of radiation and follows the principle of 4 "R" of radiobiology. The various altered fractionation schedules used are hyper-fractionation, accelerated fractionation, and hypo fractionation.
  
  
  METHODS
  We reviewed the landmark articles published in the peer reviewed journals to summarize the beneficial role of altered fractionation in the treatment of head and neck carcinoma.
  
  
  RESULTS
  Hyper-fractionation definitely gives very good overall survival benefit for locally advanced head and neck patient's equivalent to survival benefit to that of concurrent chemoradiotherapy. Adding concomitant chemotherapy to altered fractionation is a logical approach to improve survival in locally advanced head and neck cancer patients, but it may be at a cost of higher toxicity. Mild hypo fractionation may be beneficial in early laryngeal cancers and may help in achieving better local control.
  
  
  CONCLUSIONS
  Altered fractionation is a very important treatment schema and requires the reinforcement of its use.
authors.affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: drsupriyamallick@gmail.com.
authors.forename: Supriya
authors.initials: S
authors.lastname: Mallick
authors.affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rony
authors.initials: R
authors.lastname: Benson
authors.affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Pramod K
authors.initials: PK
authors.lastname: Julka
authors.affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Goura K
authors.initials: GK
authors.lastname: Rath
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000532:radiotherapy*; D059248:Chemoradiotherapy; D019583:Dose Fractionation, Radiation; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D006801:Humans; D000069473:Radiation Dose Hypofractionation; D016896:Treatment Outcome
keywords: Altered fractionation; Head and neck cancer; Radiotherapy; Squamous cell carcinoma