Radiation Oncology/Head & Neck/Palliation

Head & Neck Palliation

• Princess Margaret; 2011 (2003-2008) PMID 20950952 -- "Retrospective study of palliative radiotherapy in newly diagnosed head and neck carcinoma." (Stevens CM, Int J Radiat Oncol Biol Phys. 2011 Nov 15;81(4):958-63.)
  • Retrospective. 148 pts underwent palliative RT. Median age 72. Reason for palliative treatment was advanced locoregional disease in 24%, metastatic disease in 38%, poor performance status in 22%, or a combination in 16%. Various regimens: 50/20 (most common), 24/3, 60/25, 30/10, 60/30, 70/35. The 50/20 regimen gave 2 cycles of 25 Gy in 10 fractions separated by a 2 week break, total course of 6 weeks.
  • 70% completed the planned RT course. 73% of pts had died, with a median f/u of 4.8 months and MS of 5.2 months. Radiation dose was a significant predictor for overall survival and treatment response.
  • Conclusion: palliative RT provides symptomatic relief in most patients. In selected patients, higher dose palliative RT should be considered to maximize the durability of local control.

• UC Davis; 2008 (2001-2007) PMID 18798313 -- "Palliative radiation therapy for head and neck cancer: Toward an optimal fractionation scheme." (Chen AM, Head Neck. 2008 Sep 16. [Epub ahead of print])
  • Retrospective. 60 patients, primary H&N sites, typically painful recurrent disease. Used various regimens: 44.4/12 (RTOG 85-02 protocol @ 3.7 Gy/fx BID for 2 consecutive days at 2-3 week intervals), 70/35, 30/10, 37.5/15, 20/5
  • Palliative response: 83%, 77%, 67%, 86%, 60% (NS)
  • Toxicity: Grade 3+ 44.4/12 9% vs. other regimens 37% (SS)
  • Conclusion: All schedules effective at palliation, RTOG 85-02 scheme less toxicity