Hypofractionated, palliative radiotherapy for advanced head and neck cancer

BackgroundA 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.Materials and methodsBetween 2000 and 2005, 110 patients of unresectable HNSCC were treated with a palliative radiotherapy (40 Gy in 16 fractions). Distressing symptoms were assessed before treatment. Patients with good objective regression with acceptable toxicity received further escalation of dose till 50 Gy. We made three strata to compare symptomatic improvement namely percentage relief <50%, between 50–75% and >75% as compared to baseline.ResultsMost 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 >50 kg (p = 0.049) and radiotherapy dose of more than 40 Gy (p = 0.012) were found to be significant for PFS. Acute and late reactions were acceptable.ConclusionsThe hypofractionated radiotherapy regimen evaluated is an effective treatment modality for sustained symptoms relief with good response rates and acceptable toxicity.