Palliative radiation therapy for head and neck cancer: Toward an optimal fractionation scheme

Background. To analyze the efficacy of various fractionation schedules for the palliation of head and neck cancer with radiation therapy. Methods. Sixty patients completed palliative irradiation to primary head and neck sites. The most commonly used fractionation regimen was the one previously described by the Radiation Therapy Oncology Group (RTOG) protocol 85-02 and was designed to deliver 440 cGy using 370 cGy fractionation, administered twice a day for 2 consecutive days at 2- to 3-week intervals for 3 total cycles. Results. The rates of palliative response were 83%, 77%, 67%, 86%, and 60% among those treated using the RTOG regimen, 7000 cGy/35 fractions, 3000 cGy/10 fractions, 3750 cGy/ 15 fractions, and 2000 cGy/5 fractions, respectively (p = .42). Nine percent (2/23) of those treated with the RTOG regimen developed grade 3+ toxicity compared with 37% among those treated with other schedules (p = .01). Conclusion. Although all of the analyzed schedules were effective at providing palliation, the RTOG 85-02 regimen was associated with less toxicity.