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

Abstract

BACKGROUND: The objective of this study was to identify a subgroup of patients with head and neck squamous cell carcinoma (HNSCC) who might be suitable for hypofractionated radiotherapy (RT-hypo) during the COVID-19 pandemic. METHODS: HNSCC cases (oropharynx/larynx/hypopharynx) treated with definitive RT-hypo (60 Gy in 25 fractions over 5 weeks), moderately accelerated radiotherapy (RT-acc) alone (70 Gy in 35 fractions over 6 weeks), or concurrent chemoradiotherapy (CCRT) during 2005-2017 were included. Locoregional control (LRC) and distant control (DC) after RT-hypo, RT-acc, and CCRT were compared for various subgroups. RESULTS: The study identified 994 human papillomavirus-positive (HPV+) oropharyngeal squamous cell carcinoma cases (with 61, 254, and 679 receiving RT-hypo, RT-acc, and CCRT, respectively) and 1045 HPV-HNSCC cases (with 263, 451, and 331 receiving RT-hypo, RT-acc, and CCRT, respectively). The CCRT cohort had higher T/N categories, whereas the radiotherapy-alone patients were older. The median follow-up was 4.6 years. RT-hypo, RT-acc, and CCRT produced comparable 3-year LRC and DC for HPV+ T1-2N0-N2a disease (seventh edition of the TNM system [TNM-7];

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

“…Use of a 6 week schedule only results in a slight decrease in the number of visits for patients. Based on single centre data the hypofractionated radiotherapy alone regime 60 Gy/25# over 32 days has been suggested for T1-T3 N0-N2c HPV positive and T1-T2 N0 HPV negative tumours [10] . This regime may be more advantageous in term of reduced patient visits and lower consumption of capacity.…”

“…During the recent first peak of the COVID-19 pandemic, there has been renewed interest, including in this journal, in hypofractionated chemoradiation and hypofractionated radiation for locally advanced head and neck cancer [8] , [9] , [10] , [11] . Hypofractionation may be advantageous in reducing the risk of contracting an infective agent by reducing the number of visits to hospital.…”

New Challenges of Treatment for Locally Advanced Head and Neck Cancers in the Covid-19 Pandemic Era

“…Portaluri et al consider the rapid implementation of hypo-fractionated radiotherapy "a mix of evidence based medicine and opportunities", mentioning the risk involved in adopting this fractionation protocol if there is no solid scientific evidence, but also the advantages that hypo-fractionated radiotherapy brings in the context of the need to expose patients during treatment sessions, but also to limited treatment capabilities. In the case of HNC, the hypo-fractionated irradiation regimen was not included in the meta-analyzes and the phase 3 trials analyzing altered fractionation radiotherapy did not include a study arm with hypofractionation [35,36].…”

Caring for cancer patients in the Covid pandemic: choosing between the devil and deep sea

“…Recent guidelines have suggested omitting radiation for patients older than 65 years, using FAST and FAST forward, omitting boost, and hypofractionation [13,14]. Recent articles also suggest modification of the delivery technique to reduce treatment time [27,28].…”