Hypofractionated radiotherapy denoted as the “Christie scheme”: An effective means of palliating patients with head and neck cancers not suitable for curative treatment

Al‐Mamgani, Abrahim; Tans, Lisa; Rooij, P.H.E. van; Noever, Inge; Jong, Robert J. Baatenburg de; Levendag, Peter C.

doi:10.1080/02841860902740899

Cited by 84 publications

(63 citation statements)

References 17 publications

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“…[20][21][22] Although theoretically it may be associated with increased late side effects, 23 in more recent studies, this potentially high incidence of tissue complications has not been appreciated yet. 24,25 We chose a hypofractionated radiation scheme, as it provides an effective dose within a short overall treatment time.…”

Section: Discussionmentioning

confidence: 96%

“…For example, the "QUAD SHOT" palliative RT regimen by Corry et al 7 of 14 Gy in four fractions, which may be repeated up to two times every 4 weeks provided PR or CR in 53% of patients. Furthermore, in the study by Al-mamgani et al, 23 which included 158 patients treated with 50 Gy in 16 fractions, the overall response rate was 73%, and the subjective response rate was 57%. Finally, in the study by Mohanti et al 3 where patients received 20 Gy in five fractions and 30% of patients underwent further RT, up to 70 Gy, the response rate ranged from 89% to 96%, depending on the symptoms assessed.…”

Section: Discussionmentioning

confidence: 98%

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0-7-21 hypofractionated palliative radiotherapy: an effective treatment for advanced head and neck cancers

Nguyen¹,

Doerwald-Munoz²,

Zhang³

et al. 2015

BJR

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 98%

0-7-21 hypofractionated palliative radiotherapy: an effective treatment for advanced head and neck cancers

Nguyen¹,

Doerwald-Munoz²,

Zhang³

et al. 2015

BJR

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“…Table 4 gives a detailed review of the palliative radiotherapy schedules for locally advanced head and neck cancer and their major findings. [7151619202122232425] One randomized study reported by Weissberg et al .,[15] compared conventionally fractionated radiation of 60-70 Gy (over 6-7 weeks) with 40-48 Gy (over 2-3 weeks). Hypofractionated schedule was found to be equivalent to the conventional fractionation, in terms of palliative benefits and response with about 75% incidence of grade III mucositis.…”

Section: Discussionmentioning

confidence: 99%

Hypofractionated palliative radiotherapy in locally advanced inoperable head and neck cancer: CMC vellore experience

Das¹,

Thomas²,

Pal³

et al. 2013

Indian J Palliat Care

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Background:A novel, short duration, palliative radiotherapy schedule for inoperable head and neck cancer was evaluated in terms of palliation of cancer-related symptoms and acute toxicities.Materials and Methods:Thirty-six patients with inoperable head and neck cancer were included in the study (2010-2012). All patients received 40 Gy in 10 fractions (equivalent dose: 49.8 Gy in conventional fractionation) with 2 fractions per week. Treatment-related toxicity was assessed using Radiation Therapy Oncology Group criteria. Functional Assessment of Cancer Therapy (Head and Neck, FACT H and N) quality of life (QOL) tool was administered before starting and at the completion of radiotherapy. Mean value before and after treatment was compared (paired t-test, P = 0.05, two-tailed for significance).Results:Thirty-three patients (male: 29, female: 4, mean age: 57.8 ± 9.7 years) were included in the analysis (three patients discontinued treatment due to socioeconomic reasons). All patients had advanced inoperable head and neck cancers (27% IVA, 61% IVB, 9% IVC, TNM stage and 3% recurrent disease). Distressing pain at primary site (42%), dysphagia (18%), neck swelling (30%), and hoarseness (10%) were common presentations. Incidence of grade III mucositis and dermatitis and pain was 18%, 3%, and 24%, respectively. Planned radiotherapy without any interruptions was completed by 73% patients. QOL assessment showed improvement in social well-being (17.4 vs. 20.01, P = 0.03), but no significant change was observed in head and neck specific score (25.1 vs. 25.0, P = NS) after treatment. Reduction of pain was observed in 88% patients and 60% patients had improvement of performance status. Median overall survival of the cohort was 7 months.Conclusions:The study shows that this short duration palliative radiotherapy schedule is a clinically viable option for advanced inoperable head and neck cancer to achieve significant palliation of the main presenting symptoms like pain, dysphagia, and throat pain.

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“…Other common palliative schemes such as 20 Gy in 5 Fr and the ‘quad-shot’ also utilize hypofractionation mainly with the intention to reduce treatment time. [6],[7],[8],[9],[10],[11]…”

Section: Introductionmentioning

confidence: 99%

Palliative radiotherapy in locally advanced head and neck cancer after failure of induction chemotherapy: Comparison of two fractionation schemes

Pandey¹,

Revannasiddaiah²,

Pant³

et al. 2013

Indian J Palliat Care

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Context:Among patients with locally advanced head and neck squamous cell cancers (LAHNSCC), the prognosis after nonresponse or progression despite induction chemotherapy (IC) is dismal, and further treatment is often palliative in intent. Given that nonresponse to chemotherapy could indicate subsequent radioresistance, we intended to assess the outcomes with two different fractionation schemes.Aims:To compare the outcomes of two fractionation schemes- ’standard’ (consisting 3GyX5 daily fractions for 2 consecutive weeks) versus ‘hybrid’ (6GyX3 fractions on alternate days during the 1st week, followed by 2GyX5 daily fractions in the 2nd week).Settings and Design:Prospective randomized controlled two-arm unblinded trial.Materials and Methods:Patients with locally advanced oropharyngeal, laryngeal, and hypopharyngeal cancers treated with a minimum of two cycles of taxane, platinum, and fluorouracil-based IC were eligible if residual disease volume amounted <30 cm3. Kaplan-Meier survival curves were compared by the log-rank test. Response rates were compared using the unpaired t-test. Quality of life (QOL) was measured via patient reported questionnaires.Results:Of the initially enrolled 51 patients, 45 patients (24 from standard arm, and 21 from the hybrid arm) were eligible for analysis. Despite being underpowered to attain statistical significance, there still seemed to be a trend towards improvement in progression-free (Hazard ratio (HR) for progression: 0.5966; 95% CI 0.3216-1.1066) and overall survival (HR for death: 0.6062; 95% CI 0.2676-1.3734) with the hybrid arm when compared to the standard arm. Benefits were also observed with regards to response rates and QOL. Rate of complications were similar in both arms.Conclusions:In comparison to the routinely used palliative fractionation scheme of 30 Gray (Gy) in 10 fractions (Fr), the use of hybrid fractionation which integrates hypofractionation in the 1st week, followed by conventional fractionation in the 2nd week, could possibly offer better response rates, QOL increments, and potential survival benefits among LAHNSCC patients even after failing to respond to IC.

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Hypofractionated radiotherapy denoted as the “Christie scheme”: An effective means of palliating patients with head and neck cancers not suitable for curative treatment

Cited by 84 publications

References 17 publications

0-7-21 hypofractionated palliative radiotherapy: an effective treatment for advanced head and neck cancers

0-7-21 hypofractionated palliative radiotherapy: an effective treatment for advanced head and neck cancers

Hypofractionated palliative radiotherapy in locally advanced inoperable head and neck cancer: CMC vellore experience

Palliative radiotherapy in locally advanced head and neck cancer after failure of induction chemotherapy: Comparison of two fractionation schemes

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