Feasibility of Dose-escalated Hypofractionated Chemoradiation in Human Papilloma Virus-negative or Smoking-associated Oropharyngeal Cancer

Abstract

The schedule of 64 Gy in 25 fractions with concomitant chemotherapy is tolerable in patients with poor and intermediate prognosis OPSCC.

Practice recommendations for risk-adapted head and neck cancer radiotherapy during the COVID-19 pandemic: An ASTRO-ESTRO consensus statement

“…For early larynx cancer (T1N0), 50 Gy/16 f was most commonly recommended, 8,9 and there are data for 55 Gy/20 f in T2N0 disease. 10,11 There is limited evidence to support the use of hypofractionated radical radiation therapy over 4 to 5 weeks for locoregionally advanced disease, but panelists suggested schedules, including 55 Gy/20 f, [12][13][14][15] 62.5-64 Gy/25 f, 16,17 and 54 Gy/18 f. 18,19 Most would not use concomitant chemotherapy in this setting, and there was agreement to restrict concomitant chemotherapy to schedules of 2.4 Gy/f. Although there are data to support the use of concomitant platinum chemotherapy with higher doses per fraction, 13,14,16 panelists expressed reservations about the potential lack of benefit (eg, no apparent local control or overall survival advantage from the combination of chemotherapy with accelerated radiation therapy) 20,21 and the risk of increased acute and late toxicities.…”

Hypofractionated chemoradiation for head and cancer: Data from the PET NECK trial

“…Addition of synchronous cisplatin to a 5 week dose escalated hypofractionated accelerated radiation schedule (64 Gy in 25# over 32 days) has been tested and is currently being further evaluated in a randomised clinical trial [27] . This regime employs a fraction size of 2.56 Gy per fraction.…”

Hypofractionated radiotherapy alone with 2.4 Gy per fraction for head and neck cancer during the COVID‐19 pandemic: The Princess Margaret experience and proposal

“…Several altered-fractionation RT regimens have been reported in the literature. [29][30][31][32] Large fraction sizes may help to overcome radioresistance; however, late toxicity is a concern. Hypofractionation with 60 Gy/25f/5w with 2.4 Gy per fraction appears to be a well-tolerated regimen and is a potentially attractive approach during COVID-19 planning because of its relatively short treatment timeframe and avoidance of twice daily treatments.…”