Palliative Radiation Therapy for Head and Neck Cancers

Abstract

Patients with advanced head and neck cancers who are not eligible for curative treatment represent a challenging cohort of patients to manage given the complexity and severity of their presenting symptoms. Palliative radiation therapy, along with other systemic and surgical measures, has the potential to significantly improve the quality of life of such patients. There is little high-level evidence and a lack of consensus to direct the selection of an optimal palliative radiation regimen. An ideal palliative radiation regimen should alleviate symptoms secondary to the cancer with minimal treatment toxicity and side effects while improving a patient's quality of life. This review presents the treatment approaches, outcomes, and toxicities associated with different radiation regimens and proposes a multidisciplinary framework for the selection of an individualized treatment regimen for patients that centers around patient prognosis, goals of care, logistics of treatment, and the availability of other surgical and systemic therapies.

Palliative Hypofractionated Radiotherapy in Advanced Squamous Cell Carcinoma of Head and Neck

“…With the aim of symptom alleviation and disease control, researchers have used different radiotherapy regimens with a wide range of variation in total dose, dose per fraction and treatment duration ranging from three days to seven weeks. 8 Weissberg et al 15 assessed conventionally fractionated versus hypofractionated palliative external beam radiation therapy schedules in patients with locally recurrent or advanced head and neck cancers comparing 60 to 70 Gy in six to seven weeks against 40 to 48 Gy in 64 patients. No variances were observed in tumor control, acute side effects, or long term sequelae and since then various short-course hypofractionated regimens have emerged in advanced HNSCC.…”

“…Despite the lack of consensus guidelines, various treatment regimens have been practiced in the advanced HNSCC with acceptable results. 8 In the developing countries with a limited number of radiotherapy centers and most of the patients traveling hundreds of kilometers to seek treatment, shortening the treatment duration reduces the economic burden to the patients as well as a burden to health resources. In the current study, we aim to evaluate the role of palliative hypofractionated regimen in advanced HNSCC.…”

Role of concurrent chemoradiotherapy and stereotactic body radiation treatment for palliation of previously untreated head and neck cancers

“…These treatments will improve the locoregional control of the disease, quality of life, and possibly improve survival 1 . Two recently published review articles summarized the data on palliative radiation, and fraction schemes for head and neck cancers 2,3 …”

“…1 Two recently published review articles summarized the data on palliative radiation, and fraction schemes for head and neck cancers. 2,3 This article reviews the available literature use of concurrent chemoradiotherapy or stereotactic body radiation treatment (SBRT)…”

Radical radiotherapy in epidermoid cancer in the orbitary region: ideal scheme of hypo-fractionation in times of COVID-19: a case report

“…1 The treatment of epidermoid skin cancer with the external radiation therapy modality has been addressed in retrospective institutional studies and small phase 2 trials; there are several regimens of radiotherapy treatment as the only modality that can be used with good results, among them are some hypo fractionated schemes (decreasing in the number of treatment fractions and increasing in the daily dose above that considered as conventional fractionation) which they decrease total treatment time, and with it the risk of hospital exposure to the SARS CoV-2 virus and its consequences. [2][3][4][5][6][7] To date, there are no case reports of studies evaluating the clinical response to hypo fractionated radiotherapy in Department of Radio Oncology, UMAE IMSS Merida Yucatan, Mexico times of COVID-19, in squamous cell cancer in the face region in patients from the Yucatan Peninsula, Mexico.…”