In the wake of the COVID-19 pandemic, are there any hypofractionated regimens (without concurrent chemotherapy) that could be utilized for head /neck cancer in a post operative setting?
Agree. 50 Gy at 2.5 Gy per fraction is another option with a long track record.
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William Mendenhall
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William Mendenhall
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ENI if high grade
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Linda Chen
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In patients with pathologic risk factors that warrant adjuvant RT, patients undergo surveillance with imaging/NavDx/exam, and post-operative RT is only used when NavDx rises.
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William Mendenhall
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A very recent paper by Eric Hall and David Brenner’s group (Shuryak et al., Int J Radiation Oncol Biol Phys 2019) is titled “optimized hypofractionation can markedly improve tumor control and decrease late effects for head and neck cancer”. Using a recently improved model, they concluded that an optimal hypofractionated regimen for gross HNC of 18x 3.0 Gy substantially improves the ratio of TCP to NTCP compared with standard fractionation. They also concluded that fraction doses above 3 Gy lose an advantage regarding TCP/NTCP. Thus, 3.0 Gy fractions x5 weekly, total 33 Gy, over 11 fractions, will result in BED2 of 60.75 Gy (calculation assumed alpha/beta of 10 Gy for tumor cells and 0.7 Gy gain for each day this regimen is shorter than a six-week course of 2 Gy fractions). This is the regimen I would use if the goal is to achieve BED2 of 60Gy postoperatively.
I thought the 54 Gy/18 fx regimen was very intriguing. Has anyone had the courage to try it in a real live patient?
I have struggled with whether or not to adopt hypofractionated regimens that have limited data. Currently, I have stuck with regimens that have reasonable clinical data, similar to the burden of proof that I would normally use. That being said, I have modestly “accelerated” my adoption of regimens that are nearly ready for prime time, e.g. hypofractionated PMRT or regional nodal RT for breast. This regimen still falls well below my threshold. However, if caring for a COVID+ patient or in a hard-hit area where healthcare resources are limited, I would consider it for certain patients.