Acute xerostomia and dysphagia during the course of RT are strong prognostic factors for late dysphagia. Including accumulated acute symptom scores on a weekly basis in prediction models for late dysphagia significantly improves the identification of high-risk and low-risk patients at an early stage during treatment and might facilitate individualized treatment adaptation.

The benefit of SW-IMRT depends significantly on neck radiotherapy, tumour site and the amount of overlap between SWOARs and PTVs. Optimal clinical introduction requires a detailed evaluation and comparison between the standard (ST-IMRT) and new technique (SW-IMRT) in order to fully exploit the potential benefits.

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Objective: Evaluation of the efficacy and toxicity of splitcourse accelerated hyperfractionated irradiation (CHA-CHA) as a sole treatment for advanced head and neck (H&N) cancer patients. Methods: We enrolled 101 patients (39 in CHA-CHA and 37 in conventional (Conv.) arm completed the treatment). The CHA-CHA arm patients were irradiated twice a day, 7 days a week, using a fraction dose (fd) of 1.6 Gy up to 64 Gy with an 8-day gap in midterm. Patients in the control (Conv.) arm group were irradiated with a fd of 2 Gy, five times a week to a total dose of 72-74 Gy in the overall treatment time of 50-53 days. Quality of life (QOL) and acute mucosal reaction were evaluated during radiotherapy (RT). After RT, we followed the effect of treatment, QOL, performance status and adverse effects of radiation. For statistical analysis mainly a hierarchical multilevel modelling was used.Results: QOL was most deteriorated in the CHA-CHA arm; the CHA-CHA scheme also caused a relatively stronger acute injury. There were no significant differences in late adverse effects. In the CHA-CHA arm in 35% and in Conv. arm in 30% of patients, disease was controlled during follow-up. Tumour regression 1 year after the treatment was significantly better in the CHA-CHA arm. However, the overall survival rate analysis did not show significant difference between both arms. Conclusion: Despite differences in treatment results, we cannot conclude that split-course accelerated hyperfractionated irradiation is superior to conventionally fractionated RT as a sole treatment for advanced H&N cancer patients. Advances in knowledge: Obtained results in the context of published data support the statement that altered fractionations alone do not give an advantage for advanced H&N cancer patients.There are, and have been, many attempts to create a clear and effective treatment modality for advanced inoperable head and neck (H&N) cancers. The most common are different combinations of chemoradiotherapy, or different schedules of altered and usually intensive radiation treatment. It is clear that intense dose delivery combined with a high total dose (TD) and short treatment time gives a higher probability of tumour destruction; unfortunately, it is also connected with a higher, usually unacceptable, risk of normal tissue damage. One of the causes of radiation toxicity in such cases is the inability of sufficient repair of healthy tissue damage.The reason for this is the intensity of dose delivery and the lack of time for repopulation of normal cells and proper repair. On the other hand, the accelerated repopulation of squamous cancer cells starts 4 weeks after radiotherapy (RT); therefore, radiation treatment should be completed in that time. Considering the aforementioned facts, we tried to construct a very intense and short RT schedule allowing for normal tissue (mainly mucosa) repair. We went back to the old concept of split-course RT and combined it with accelerated, continuous, intense hyperfractionation.Finally, we proposed twice-a-day irradiation, usi...

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