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Gap compensation during accelerated hypofractionated radiotherapy in head and neck cancer

Published online by Cambridge University Press:  01 March 2008

Paul Sanghera ,
John Arnfield ,
Chris McConkey  and
Andrew Hartley
Paul Sanghera
Affiliation:
Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK
John Arnfield
Affiliation:
Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK
Chris McConkey
Affiliation:
Clinical Trials Unit, University of Warwick, UK
Andrew Hartley*
Affiliation:
Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK
*
Correspondence to: Andrew Hartley, Cancer Centre at Queen Elizabeth Hospital, Birmingham B15 2TH, UK. Email: [email protected]
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Abstract

Introduction: In squamous-cell carcinoma (SCC) of the head and neck, unplanned gaps risk prolongation of the overall treatment time (OTT) and reduction in tumour control. This audit determines whether further acceleration can safely be employed to compensate for missed treatments during accelerated hypofractionated radiotherapy.

Methods: Patients receiving accelerated hypofractionated radiotherapy for SCC of the head and neck were prospectively audited. Outcome measures were OTT, degree of compensation and acute toxicity determined by incidence of grade 3 mucositis, prolonged grade 3 mucositis, grade 3 dysphagia and pain.

Results: In the 87 patients identified, the dose administered was 55 Gy in 20 fractions (81 patients), 50 Gy in 20 fractions (1 patient) and 50 Gy in 16 fractions (5 patients). Of those patients receiving 20 fractions, 94% completed within 28 days. Grade 3 mucositis was seen in 56 patients (64%). Compensating for unplanned gaps did not result in any significant increase in toxicity. Administering 6 fractions/week, as compensation, was associated with a lower pain score (p = 0.003) as was receiving 2 fractions on the same day (p = 0.0004).

Conclusions: Accelerated hypofractionation is tolerable with most patients completing treatment within the planned OTT. When unplanned gaps occur, then compensation by further acceleration is possible.

Keywords

Accelerationhead and neck cancerhypofractionationRadiotherapysquamous-cell carcinoma
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 7 , Issue 1 , March 2008 , pp. 31 - 38
Copyright
Copyright © Cambridge University Press 2008

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