Article ; Online: Resource-sparing curative-intent hypofractionated-accelerated radiotherapy in head and neck cancer: More relevant than ever before in the COVID era.
2020 Volume 111, Page(s) 105045
Abstract: ... of curative-intent hypofractionated-accelerated RT schedule delivering 55 Gy in 20 fractions over 4 weeks ... The incidence of head and neck squamous cell carcinoma (HNSCC) is increasing worldwide, with over ... and head-neck), given the cost-effectiveness, convenience, and compliance to short-course RT regimens ...
| Abstract | The incidence of head and neck squamous cell carcinoma (HNSCC) is increasing worldwide, with over three quarters of cases now diagnosed in low and middle-income countries (LMICs) with resource-constraints. Loco-regional recurrence remains the predominant pattern of failure mandating adequate local therapy for acceptable loco-regional control and survival. There is high-quality evidence that intensification of treatment by either by adding concurrent chemotherapy or by altering radiotherapy (RT) fractionation improves outcomes in the curative-intent management of loco-regionally advanced HNSCC. Even conservative estimates indicate that >50% of patients in LMIC are unlikely to get access to timely RT, which will only get compounded with the coronavirus disease (COVID)-19 pandemic. The radiation oncology community has been systematically testing altered fractionation schedules in several solid cancers (breast, lung, and head-neck), given the cost-effectiveness, convenience, and compliance to short-course RT regimens. Radiobiological modelling suggests that standard fractionation of 6-7 weeks in HNSCC can be compressed safely into a 4-week schedule to counter accelerated repopulation by increasing the dose per fraction and delivering 5 fractions per week which is currently being tested in the ongoing multicentric trial of hypo- vs normo-fractionated accelerated RT (HYPNO study). Herein, we discuss the radiobiological basis of curative-intent hypofractionated-accelerated RT schedule delivering 55 Gy in 20 fractions over 4 weeks in HNSCC followed by critical appraisal of the published literature on such regimens with concurrent systemic therapy and its inherent resource-sparing potential applicable across large parts of the world particularly in the context of the ongoing COVID-19 pandemic. |
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| MeSH term(s) | Clinical Trials, Phase III as Topic ; Humans ; Models, Biological ; Radiation Dose Hypofractionation ; Squamous Cell Carcinoma of Head and Neck/radiotherapy ; Time Factors ; Treatment Outcome |
| Keywords | covid19 |
| Language | English |
| Publishing date | 2020-10-20 |
| Publishing country | England |
| Document type | Journal Article ; Systematic Review |
| ZDB-ID | 1120465-5 |
| ISSN | 1879-0593 ; 0964-1955 ; 1368-8375 |
| ISSN (online) | 1879-0593 |
| ISSN | 0964-1955 ; 1368-8375 |
| DOI | 10.1016/j.oraloncology.2020.105045 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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