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Altered Fractionation for Head and Neck Cancer

Altered Fractionation for Head and Neck Cancer

The optimal fractionation schedule has
been an area of intense clinical research since the beginning of radiotherapy.
Over the years, there have been many attempts to improve the outcome of
radiotherapy by altering the overall treatment time, total dose, and number of
fractions. The majority of clinical trials have tested hyperfractionation,
accelerated fractionation, or their variants against "standard"
once-daily fractionation. Altered fractionation radiotherapy has been most
extensively studied in the treatment of head and neck cancer.

In this issue, Dr. Adam Garden succinctly reviews the
rationale for hyperfractionation and accelerated fractionation, as well as the
results of randomized clinical trials of altered fractionation radiotherapy in
head and neck cancer. This will be a valuable reference for all those interested
in this topic.

Improved Locoregional Control With Altered Fractionation

As Dr. Garden points out, the results of randomized trials
thus far suggest that locoregional control in head and neck cancer can be
improved by either an increased total dose (using hyperfractionation) or a
shortened overall treatment time (using accelerated fractionation). However,
there is no consensus about an "optimal" fractionation schedule.
Indeed, the optimal fractionation schedule will be dictated by other practical
considerations, such as patient compliance, available resources, and cost.

It should also be noted that the advantage of altered
fractionation radiotherapy is seen primarily in patients with intermediate- to
advanced-stage (stage II-IV) disease. Whether there is any therapeutic gain
for early (stage I) disease has not been evaluated.

Normal Tissue Toxicity

Randomized trials of altered fractionation radiotherapy in
head and neck cancer have consistently shown increased acute toxicity, primarily
mucositis. Increased late effects in normal tissues also have been demonstrated
with some accelerated fractionation schedules.

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