Vol 15, No 4 (2021)
Research paper
Published online: 2021-07-15

open access

Page views 5943
Article views/downloads 311
Get Citation

Connect on Social Media

Connect on Social Media

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

Suman Meyur1, Suparna Kanti Pal2, Sumana Maiti1, Siddhartha Basu1
DOI: 10.5603/PMPI.2021.0022
Palliat Med Pract 2021;15(4):289-298.


Introduction: For palliative treatment in patients with advanced inoperable stage IV head and neck cancer
hypofractionated 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 of
objective treatment response and survival along with self-reported quality of life.

Patients and methods: 30 Patients, having pathologically proven advanced and metastatic non-nasopharyngeal
squamous cell carcinoma of Head and Neck (Stage IV) attending the Radiotherapy Department
of Hospital were allocated to the prescribed hypofractionation regime with 35 Gray in 7 fractions, given
as 2 days a week (total 3.5 weeks). In patients with good response and tolerability, 10 Gray boosts in
2 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 significant
improvement of quality of life was reported in terms of global health score, functional score and symptoms
score. 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 rate
and improved quality of life immediately after treatment along with a better one-year overall survival rate.

Article available in PDF format

View PDF Download PDF file


  1. Kulkarni M. Head and Neck Cancer Burden in India. International Journal of Head and Neck Surgery. 2013; 4(1): 29–35.
  2. Murthy NS, Chaudhry K, Rath GK. Burden of cancer and projections for 2016, Indian scenario: gaps in the availability of radiotherapy treatment facilities. Asian Pac J Cancer Prev. 2008; 9(4): 671–677.
  3. Leemans CR, Braakhuis BJM, Brakenhoff RH. The molecular biology of head and neck cancer. Nat Rev Cancer. 2011; 11(1): 9–22.
  4. Chen AM, Vaughan A, Narayan S, et al. Palliative radiation therapy for head and neck cancer: toward an optimal fractionation scheme. Head Neck. 2008; 30(12): 1586–1591.
  5. Johnstone C, Lutz ST. The role of hypofractionated radiation in the management of non-osseous metastatic or uncontrolled local cancer. Ann Palliat Med. 2014; 3(4): 291–303.
  6. Pulte D, Brenner H. Changes in survival in head and neck cancers in the late 20th and early 21st century: a period analysis. Oncologist. 2010; 15(9): 994–1001.
  7. Monnier L, Touboul E, Durdux C, et al. Hypofractionated palliative radiotherapy for advanced head and neck cancer: the IHF2SQ regimen. Head Neck. 2013; 35(12): 1683–1688.
  8. Smith GL, Smith BD. Radiation treatment in older patients: a framework for clinical decision making. J Clin Oncol. 2014; 32(24): 2669–2678.
  9. Corry J, Peters LJ, Costa ID', et al. The 'QUAD SHOT' – a phase II study of palliative radiotherapy for incurable head and neck cancer. Radiother Oncol. 2005; 77(2): 137–142.
  10. Ghoshal S, Chakraborty S, Moudgil N, et al. Quad shot: a short but effective schedule for palliative radiation for head and neck carcinoma. Indian J Palliat Care. 2009; 15(2): 137–140.
  11. Al-mamgani A, Tans L, Van rooij PHE, et al. Hypofractionated radiotherapy denoted as the "Christie scheme": an effective means of palliating patients with head and neck cancers not suitable for curative treatment. Acta Oncol. 2009; 48(4): 562–570.
  12. Ali MY, Alam M, Mannan MA, et al. Short Course Palliative Radiotherapy in Locally Advanced Squamous Cell Carcinoma of Head and Neck. Journal of Armed Forces Medical College, Bangladesh. 1970; 6(1): 16–20.
  13. Porceddu SV, Rosser B, Burmeister BH, et al. Hypofractionated radiotherapy for the palliation of advanced head and neck cancer in patients unsuitable for curative treatment--"Hypo Trial". Radiother Oncol. 2007; 85(3): 456–462.
  14. Zubrod C, Schneiderman M, Frei E, et al. Appraisal of methods for the study of chemotherapy of cancer in man: Comparative therapeutic trial of nitrogen mustard and triethylene thiophosphoramide. Journal of Chronic Diseases. 1960; 11(1): 7–33.
  15. Eldridge SM, Chan CL, Campbell MJ, et al. PAFS consensus group. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. BMJ. 2016; 355: i5239.
  16. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0(2009) US Department of Health and Human Services. http://www.hrc.govt.nz/sites/default/files/CTCAE%20manual%20-%20DMCC.pdf (05.08.2009).
  17. Schwartz LH, Litière S, de Vries E, et al. RECIST 1.1-Update and clarification: From the RECIST committee. Eur J Cancer. 2016; 62: 132–137.
  18. Singer S, Araújo C, Arraras JI, et al. EORTC Quality of Life and the EORTC Head and Neck Cancer Groups. Measuring quality of life in patients with head and neck cancer: Update of the EORTC QLQ-H&N Module, Phase III. Head Neck. 2015; 37(9): 1358–1367.
  19. Cocks H, Ah-See K, Capel M, et al. Palliative and supportive care in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016; 130(S2): S198–S207.
  20. Yang YC, Chiang CS. Challenges of Using High-Dose Fractionation Radiotherapy in Combination Therapy. Front Oncol. 2016; 6: 165.
  21. Brown JM, Carlson DJ, Brenner DJ. The tumor radiobiology of SRS and SBRT: are more than the 5 Rs involved? Int J Radiat Oncol Biol Phys. 2014; 88(2): 254–262.
  22. Das S, Thomas S, Pal SK, et al. Hypofractionated Palliative Radiotherapy in Locally Advanced Inoperable Head and Neck Cancer: CMC Vellore Experience. Indian J Palliat Care. 2013; 19(2): 93–98.
  23. Ghoshal S, Patel F, Mudgil N, et al. Palliative radiotherapy in locally advanced head and neck cancer – a prospective trial. Indian J Palliat Care. 2004; 10(1): 19.
  24. Hagen NA, Biondo PD, Brasher PMA, et al. Formal feasibility studies in palliative care: why they are important and how to conduct them. J Pain Symptom Manage. 2011; 42(2): 278–289.
  25. Agarwal JP, Nemade B, Murthy V, et al. Hypofractionated, palliative radiotherapy for advanced head and neck cancer. Radiother Oncol. 2008; 89(1): 51–56.
  26. Al-Mamgani A, Kessels R, Verhoef CG, et al. Randomized controlled trial to identify the optimal radiotherapy scheme for palliative treatment of incurable head and neck squamous cell carcinoma. Radiother Oncol. 2020; 149: 181–188.
  27. Hall EJ, Giaccia AJ. Radiobiology for the Radiologist. Lippincott Williams & Wilkins, Philadelphia 2006.
  28. Brenner DJ. The linear-quadratic model is an appropriate methodology for determining isoeffective doses at large doses per fraction. Semin Radiat Oncol. 2008; 18(4): 234–239.
  29. Eisbruch A, Harris J, Garden AS, et al. Multi-institutional trial of accelerated hypofractionated intensity-modulated radiation therapy for early-stage oropharyngeal cancer (RTOG 00-22). Int J Radiat Oncol Biol Phys. 2010; 76(5): 1333–1338.
  30. Choudhary A, Gupta A. Conventional Fractionation versus Quad Shot in Advanced Head-and-Neck Cancers: A Randomized Controlled Trial. Indian J Palliat Care. 2019; 25(4): 527–534.
  31. Grewal AS, Jones J, Lin A. Palliative Radiation Therapy for Head and Neck Cancers. Int J Radiat Oncol Biol Phys. 2019; 105(2): 254–266.
  32. Fabian A, Domschikowski J, Hoffmann M, et al. Patient-Reported Outcomes Assessing the Impact of Palliative Radiotherapy on Quality of Life and Symptom Burden in Head and Neck Cancer Patients: A Systematic Review. Front Oncol. 2021; 11: 683042.