The impact of missed fractions in head and neck radiotherapy and how they can be minimised

Radiotherapy is an effective treatment for cancer, especially in cases of early stage disease, hence its continued routine use in Oncology. Overall treatment time is a significant factor which influences the efficacy of radiotherapy treatment. The accelerated reproduction of tumour clonogenic cells is considered to be a major contributory cause for reduced local control when treatment time is extended without dose compensation.It has been reported that even a one day gap can be damaging to treatment outcome with a reduction in local control being estimated at 1.4% per day of missed radiotherapy. With recent treatment compliance rates of 48.9% being observed in head and neck radiotherapy patients these factors provide the rationale for such a review. This paper reviews the current literature on the impact of missed fractions in radiotherapy for SCC head and neck and provide recommendations as to how missed fractions can be minimised.