Table 2.
Review of literature on hypofractionated palliative radiotherapy for head-and-neck cancer
| Authors | Years | Number of patients (n) | Dose and fractionation | Dose per fraction | Number of fractions per day | Overall treatment time | Response | Toxicities |
|---|---|---|---|---|---|---|---|---|
| Erkal et al.[25] | 2001 | Total 40 22 10 |
30 Gy/10# 20 Gy/2# |
3 Gy 2 Gy |
OD OD |
2 weeks 1 week (split course 1-week gap) |
1-year response=77% 1-year response=48% |
No patients Sustained severe acute complication |
| Lusinchi et al.[26] | 1990 | 54 | 30 Gy/15# | 2 Gy | OD | 3 weeks | 33% discontinued RT | |
| Wendt et al.[27] | 1987 | 34 | 70.2 Gy/39# | 1.8 Gy | BD | 51 days (3 cycles every 3-4 weeks) Accelerated split course with simultaneous chemotherapy |
Local control rates 87% and 81% | Overall toxicity was tolerable |
| Paris et al.[24] | 1993 (phase 2 study) | 25 | 44 Gy/12# | 3.7 Gy | BD | 9 weeks (3 cycles every 3 weeks) | 84.6% achieved good palliation | The acute toxicity consisted of the expected skin changes, dysphasia, taste blindness, and dryness of the mouth |
| Minatel et al.[28] | 1998 | 58 | 50 Gy/25# | 2.5 Gy | OD | 9 weeks Weeks gap after half the dose | Symptom relief in 81% | Grade 3 mucosal toxicity in 27/58 patients |
| Ghoshal et al.[18] | 2004 | 25 | 30 Gy/10# | 3 Gy | OD | 2 weeks | Significant symptom relief in >91% | 17 patients had Grade 1 and 8 patients had Grade 2 mucositis |
| Mohanti[20] | 2004 | 505 | 20 Gy/5# | 4 Gy | OD | 1 week | 47%-59% symptom relief | Confined to dry desquamation and patchy mucositis |
| Corry et al.[17] | 2005 | 30 | 42 Gy/4# | 3.5 Gy | BD | 2 consecutive days (3 cycles every 4 weeks) | 53% response rate | 3/27 patients had Grade 2 mucositis and 14/27 Patients had Grade 1 dermatitis. No patients |
| Porceddu et al.[29] | 2007 (phase 2 study) | 35 | 30 Gy/5 fractions at 2/week, at least 3 days apart, with an additional boost of 6 Gy for small volume disease (63 cm) in suitable patients |
6 Gy | OD | 1 week | Overall response rate 80% | Grade 3 mucositis and dysphagia were experienced in 26% and 11%, respectively |
| Agarwal et al.[11] | 2008 | 110 | 40 Gy/16# | 2.5 Gy | OD | 3.5 weeks | Symptom relief in 74% | Grade 3 mucositis 69% |
| Ghoshal et al.[19] | 2009 | 15 | 42 Gy/4# | 3.5 Gy | BD | 2 consecutive days (3 cycles every 4 weeks) | 50% objective response 54% Grade 1 and 2 mucositis | 54% Grade 1 and 2 mucositis |
| Paliwal et al.[21] | 2012 | 50 | 20 Gy/5# | 4 Gy | OD | 1 week | Partial response in 92% | Grade 3 mucositis 4% |
| Das et al.[23] | 2013 | 36 | 40 Gy/10# | 4 Gy | OD | 5 weeks (2 fractions per week) | Pain relief in 88% | Grade 3 mucositis and dermatitis was 18% and 3% |
| Chen et al.[30] | 2008 | Total 60 23 13 12 7 5 |
44.4 Gy/3# 70 Gy/35# 30 Gy/10# 37.5 Gy/15# 20 Gy/5# |
3.7 Gy 2 Gy 3 Gy 2.5 Gy 4 Gy |
BD OD OD OD OD |
2 consecutive days (3 cycles every 2-3 weeks) RTOG 85-02 schedule 7 weeks 2 weeks 3 weeks 1 week |
Rate of palliative response 83% Rate of palliative response 77% Rate of palliative response 67% Rate of palliative response 86% Rate of palliative response 60% |
Grade 3+toxicity 9% Grade 3+toxicity 38% Grade 3+toxicity 42% Grade 3+toxicity 29% Grade 3+toxicity 20% |
| Al-Mamgani et al.[10] | 2009 | 158 | 50 Gy/16 # | 3.125 Gy | OD | 22-24 days | Overall response rate of 73% | Acute Grade 3 skin and mucosal toxicities in 45% and 65%, respectively. Severe late toxicity in 4.5% |
| Kancherla et al.[31] | 2011 | 33 | 20 Gy/5# Followed by 2-week gap followed by 20 Gy/5# | 4 Gy | OD | 4 weeks | Response rate in 72% Symptom relief in 79% |
Acute Grade 3 skin and mucosal toxicities in 9% and 6% respectively |
| Nguyen et al.[32] | 2015 | 110 | 24 Gy/8# | 3 Gy | OD | 3 weeks (once a week 0-7-21 regimen) | Overall response>80% | Two (2.1%) patients died unrelated to treatment Three (3.2%) patients required admission during treatments, including one owing to Grade 3 mucositis (1%) |
| Lok et al.[33] | 2012 | 75 | 42 Gy/4# | 3.5 Gy | BD | 2 consecutive days (3 cycles every 4 weeks) RTOG 85-06 study, Quad Shot |
Rate of palliative response 65% | Grade 3 toxicity in 5% |
| Murthy et al.[22] | 2016 | 93 | 32 Gy/8# | 4 Gy | OD | 4 weeks (twice weekly) | Response rate>40% Pain score improved in>76% |
Acute Grade 3 mucositis was seen in one patient (1.2%) while none had Grade 3 skin reactions |
| Straube et al.[34] | 2016 | 27 | SIB IMRT Dose prescription was 50% of PTV receiving the prescribed dose of 40 Gy (D50=40 Gy) in 20 fractions. SIB of 54 Gy in 20 fractions was applied to the GTV+5 mm margin (CTV_SIB) | 2 Gy 2.7 Gy to the SIB site | OD | 4 weeks | 75% of patients showed an early local response | Most patients developed mild-to-moderate acute toxicities; only one patient had Grade 4 mucositis |
| Present study | 2019 | 25 | 42 Gy/4# | 3.5 Gy | BD | 2 consecutive days (3 cycles every 4 weeks) | Overall response 73.91% and 83.60% for primary lesion and nodal site respectively | No Grade 3 toxicity. Acute Grade 2 mucosal toxicities in 13.04% |
| 25 | 30 Gy/10# | 3 Gy | OD | 2 weeks | Overall response 78.26% and 73.91% for primary lesion and nodal site, respectively | Acute Grade 3 mucosal and skin toxicities in 56.52% and 52.17%, respectively |
SIB: Simultaneous integrated boost, IMRT: Intensity modulated radiation therapy, RTOG: Radiation therapy oncology group, CTV: Clinical target volume, GTV: Gross tumour volume, PTV: Planning target volume, OD: Once a day, BD: Twice a day