title: High-dose hypofractionated radiotherapy is effective and safe for tumors in the head-and-neck.
abstract: High-dose, hypofractionated radiotherapy (HFRT) is sometimes used to treat malignancy in the head-and-neck (HN), both in the curative and palliative setting. Its safety and efficacy have been reported in small studies and are still controversial.
  
  
  
  We retrospectively evaluated the outcomes and toxicities of HFRT, including ultra-high-dose fractionation schemes (⩾8Gray per fraction), for HN malignancies.
  
  
  
  A total of 62 sites of measurable gross disease in 48 patients were analyzed. The median follow-up was 54.3months among five survivors and 6.0months in the remaining patients. Median RT dose was 30Gray in 5 fractions; 20/62 lesions (32%) received dose-per-fraction of ⩾8Gray. Overall response rate at first follow-up was 79%. One-year local-progression free rate was 50%. On multivariate analysis for locoregional control, dose-per-fraction ⩾6Gray was associated with control (p=0.04) and previous radiation was associated with inferior control (p=0.04). Patients who achieved complete response to RT had longer survival than those who did not (p=0.01). Increased toxicity rates were not observed among patients treated with dose-per-fraction ⩾8Gray; only re-irradiation increased toxicity rates.
  
  
  
  Despite the poor prognostic features noted in this cohort of patients with HN malignancies, HFRT was associated with high response rates, good local control, and acceptable toxicity. Sites that were treated with 6Gray per fraction or higher and had not been previously irradiated had the best disease control. A prospective trial is warranted to further refine the use and indications of HFRT in this setting.
authors.affiliation: Department of Radiation Medicine, Northwell Health, New York, NY, United States; Hofstra Northwell School of Medicine, Hempstead, NY, United States; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States.
authors.forename: Sewit
authors.initials: S
authors.lastname: Teckie
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States.
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Lok
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States.
authors.forename: Shyam
authors.initials: S
authors.lastname: Rao
authors.affiliation: Department of General Surgery, Weill Cornell Medicine, 525 East 68th Street, F-734, Box 207, New York, NY 10021, United States.
authors.forename: Stanley I
authors.initials: SI
authors.lastname: Gutiontov
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States.
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Yamada
authors.affiliation: Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States.
authors.forename: Sean L
authors.initials: SL
authors.lastname: Berry
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zelefsky
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States. Electronic address: leen2@mskcc.org.
authors.forename: Nancy Y
authors.initials: NY
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019583:Dose Fractionation, Radiation; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D055815:Young Adult
keywords: Head-and-neck cancer; High-dose radiation therapy; Palliation; Recurrent head and neck cancer; Stereotactic body radiation therapy