Hypofractionated Palliative Radiotherapy in
Advanced Head and Neck Malignancy

PN SHUKLA, M GAIROLA, PK JULKA
DEPARTMENT OF RADIOTHERAPY, ALL INDIA INSTITUTE OF MEDICAL SCIENCES,
NEW DELHI, INDIA

Abstract
Introduction: Hypofractionated radiotherapy uses a large dose of radiation in each fraction. This reduces the number of visits to hospital for patients and is also useful for reducing the number of patients waiting for radiotherapy. However, hypofractionated radiotherapy has a high risk for late radiation side effects.

Materials and Methods: Seventy eight patients with advanced head and neck squamous cell carcinoma received palliative radiotherapy between July 2000 and July 2001. Forty six patients received 20 Gy in 5 fractions over 1 week and 32 patients received 20 Gy in 4 weekly fractions over 22 days. The subjective and objective response was retrospectively evaluated.

Results: Subjective relief of symptoms in the daily and weekly fraction groups was found for 39.0% and 37.5% of patients, respectively. The objective response (complete response and partial response) of the primary tumour for the daily and weekly radiation groups was 42.5% and 9.6%, respectively, and the lymph node response was 32.4% and 4.0%, respectively.

Conclusion: Hypofractionated radiotherapy is effective for palliation of symptoms of advanced head and neck malignancy. Using this method means that a larger number of patients may be treated in a given period. Patients with a significant objective response should be considered for further curative management.