Accelerated Hypofractionated Palliative Radiotherapy Vs Standard Hypofractionated Palliative Radiotherapy With Concurrent Chemotherapy In Locally Advanced Head And Neck Carcinoma: A Randomised Controlled Study

In patients with locally advanced head and neck carcinoma, Palliativeradiotherapy, in general, has the potential to greatly improve the quality oflife (QoL) of these patients and may actually increase overall survival. Considerationsfor an optimal palliative radiotherapy schedule are: significant tumourregression and symptom control within a short overall treatment time (OTT) withminimal side effects. Frequently some form of hypofractionation is opted for.The benefit of an increased tumour cell kill because of the large fraction sizein a short OTT is counteracted, from radiobiological point of view, by anincreased potential for late side effects. However, late radiation toxicity isoften less relevant in patients treated in palliative setting. Accelerated fractionationis another option. The rationale for accelerated fractionation is thatreduction in overall treatment time decreases the opportunity for tumour cellregeneration, thereby increasing the probability of tumour control for a giventotal dose. Because overall treatment time has little influence on theprobability of late normal tissue injury, a therapeutic gain should berealized, provided the interval between dose fractions is sufficient forcomplete repair to take place. Thepresent study has been designed to address the benefit of accelerated moderately-hypofractionatedpalliative radiotherapy with concurrent chemotherapy over standard hypofractionatedpalliative radiotherapy with concurrent chemotherapy on the background ofprevious study from this centre.