Palliation using hypofractionated radiotherapy

Abstract

Hypofractionated radiotherapy—a form of radiotherapy in which larger doses are used per fraction—shows encouraging results for the palliation of patients with advanced head and neck cancer who are unsuitable for curative treatment (Radiother Oncol 2007; 85: 456–62). “Approximately 30% of head and neck cancer patients presenting to hospitals in developed countries have either incurable disease or are not fi t for curative treatment”, says fi rst author Sandro Porceddu (Princess Alexandra Hospital, Brisbane, Australia). “Unfortunately, the median survival of these patients is in the order of 6 months”, he adds. Porceddu and co-workers did a phase II trial, in which 35 patients with incurable squamous-cell carcinoma of the head and neck were assigned to a course of hypofractionated radiotherapy. The radiotherapy dose was 30 Gy in fi ve fractions administered twice weekly (at least 3 days apart) over 2·5 weeks, with an additional boost of 6 Gy in suitable patients who had small-volume disease (3 cm or less). Of the 35 patients, 27 were eligible for primary-site analysis; 15 had a complete response and fi ve had a partial response. Overall response was 80% (28 of 35). The most common toxic eff ects were grade 3 mucositis in nine patients and dysphagia in four patients. 21 patients were assessed for quality of life and symptom control; 13 patients had an overall quality of life improvement and 14 reported an improvement in pain. However, progression-free and overall survival remained short, with median time to progression and death at 3·9 months and 6·1 months, respectively. Seven patients survived beyond 12 months after the conclusion of treatment. “The treatment was well tolerated”, comments Porceddu. He explains, “One of the major benefi ts of this trial is that the treatment is delivered over a short period of time, which is advantageous for patients, and it utilises very little in the way of radiotherapy resources, which is important for busy and overloaded radiotherapy centres”. “The trial is impressive as it off ers an eff ective palliation for patients with advanced head and neck cancer, with an optimum compliance”, comments Basudeb Bhar (Calcutta Medical Research Institute, Calcutta, India). “However, this regimen should be further tested, preferably in combination with other options, so that it can also have an impact on the patient’s survival.”