A pilot study on feasibility, toxicity and efficacy of novel hypofractionated radiation therapy in advanced nonnasopharyngeal head and neck carcinoma treated with palliative intent

Introduction: For palliative treatment in patients with advanced inoperable stage IV head and neck cancerhypofractionated radiotherapy is an efficient, cost-effective option, providing a logistic advantage.Though there are multiple regimens prescribed, no standard of care has been confirmed. In this study,a novel hypofractionated regimen has been tested for feasibility and toxicity along with an assessment ofobjective treatment response and survival along with self-reported quality of life. Patients and methods: 30 Patients, having pathologically proven advanced and metastatic non-nasopharyngealsquamous cell carcinoma of Head and Neck (Stage IV) attending the Radiotherapy Departmentof Hospital were allocated to the prescribed hypofractionation regime with 35 Gray in 7 fractions, givenas 2 days a week (total 3.5 weeks). In patients with good response and tolerability, 10 Gray boosts in2 fractions were given. Patients were followed up at regular intervals for at least 1 year. Results: The regimen faced a 97% treatment completion rate. Mean time to completion (from first contact)is 5.8 (95% CI = 5.7–6.0) weeks. The toxicity of this treatment regimen was tolerable with 23.3%acute and 33.3% incidence of chronic grade 3/4 toxicities. Objective response rate of this study was 66.7%(p = 0.001) with further 16.7% patients having stable disease. After one month of treatment significantimprovement of quality of life was reported in terms of global health score, functional score and symptomsscore. Mean progression-free survival is 34.4 (95% CI = 27.8–41.1) weeks with 49.4 (95% CI = 44.3–54.5)weeks of overall survival in 1 year follow up period. Conclusions: The regimen is well tolerated and is highly feasible and has provided a good response rateand improved quality of life immediately after treatment along with a better one-year overall survival rate