Palliative RT in HN cancer
Hypofractionated, palliative radiotherapy for advanced head and neck cancer

https://doi.org/10.1016/j.radonc.2008.06.007Get rights and content

Abstract

Background

A 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 methods

Between 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.

Results

Most 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.

Conclusions

The hypofractionated radiotherapy regimen evaluated is an effective treatment modality for sustained symptoms relief with good response rates and acceptable toxicity.

Section snippets

Material and methods

  • 1.

    Between January 2000 and June 2005, 110 previously untreated, advanced, unresectable, non-nasopharyngeal head and neck cancer patients formed the study cohort. The eligibility criteria were

    • Stage IVB disease, i.e., surgically unresectable due to disease extent (e.g., infratemporal fossa extension, carotid invasion, prevertebral fascia invasion, etc., or fixed/fungating neck nodal masses).

    • Stage III or IVA disease with poor performance status.

    • No previous history of radiotherapy or chemotherapy.

Results

The demographic data of 110 patients are shown in Table 1. The common distressing complaints at presentation included pain (109 patients, 99%), dysphagia (97 patients, 88%), neck nodal swelling (95 patients, 86%), and hoarseness (30 patients, 27%). The severity of pain and dysphagia is shown in Table 2. Based on the severity of pain, approximately 80% of the patients required analgesics in the form of either NSAID alone or in combination with opioid or morphine at baseline. Overwhelming

Discussion

In the present study, patients with advanced incurable, non-nasopharyngeal head and neck cancers were treated with 40 Gy in 16 fractions as palliative hypofractionated radiotherapy with selective dose escalation in just over 25% patients up to 50 Gy in 20 fractions. Significant and sustained symptomatic improvement (>75%) was seen in 75 of 86 (87%) patients who had at least 3 months of follow-up. The 1-year progression-free survival of the entire cohort was 55.1%, substantially better than the

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