Abstract
Palliative radiotherapy to patients with head and neck cancer is often necessary, but there is a substantial variation in the treatment regimens reported in the literature, and consensus on the most appropriate schedules does not exist. In order to minimize acute toxicity while at the same time trying to achieve prolonged tumor control, a long hypofractionated regimen has been used routinely in Denmark. In the current retrospective study, we investigated the outcome in patients intended for palliative radiotherapy with this regimen. Patients with newly diagnosed head and neck cancer treated with palliative radiotherapy of 52-56 Gy in 13-14 fractions twice weekly from 2009 to 2014 were included. Patients were excluded if they had previously received radiotherapy. Data on disease location, stage, patient performance status (PS), treatment response, acute skin and mucosal toxicity, and late fibrosis were collected prospectively and supplemented with information from medical records. 77 patients were included in the study. Fifty-eight patients (75%) completed the intended treatment. Loco-regional tumor response (complete or partial) was evaluated 2 months posttreatment and observed in 45% of the entire population corresponding to 71% of patients alive. PS had a significant influence on survival (p = 0.007) and on not completing the intended treatment. Grade III or IV acute mucositis were observed in 25%, and grade III or IV acute dermatitis observed in 15%. Palliative hypofractionated radiotherapy with 52-56 Gy in 13-14 fractions shows good tumor response and tolerability in a vulnerable patient population. However, it may not be suited for patients in poor PS.
Highlights
IntroductionIn 2012, there were 686,000 new cases, accounting for approximately 5% of all new cancer cases worldwide [1]
Cancer of the head and neck is a common malignant disease
Patients with head and neck cancer often present with pain and dysphagia as primary symptoms, and left untreated the prognosis for these patients is very poor with a median survival below 4 months [2]
Summary
In 2012, there were 686,000 new cases, accounting for approximately 5% of all new cancer cases worldwide [1] This included cancers of the oral cavity, pharynx, and larynx, with most of them being squamous cell carcinomas. Acute morbidity occurs over a period of several weeks to months and includes severe mucositis, pain, and dysphagia, which is not tolerable for all patients. As advanced head and neck cancer is often associated with severe local morbidity, including ulceration, pain, and dysphagia, disease control and symptomatic treatment are still necessary. Palliative radiotherapy is a reasonable treatment option in patients with primary metastatic disease or when treatment of locally advanced disease with curative intent is not possible due to comorbidity or poor performance status (PS). In the current retrospective study, we investigated the outcome in patients intended for palliative radiotherapy with this regimen
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