Altered-fractionated radiotherapy in locally advanced head and neck cancer

Abstract

Purpose of review: To revisit the biologic rationale, the clinical methodology, the outcome and perspectives of altered fractionation in head and neck oncology.

Recent findings: Various prospective trials and meta-analyses clearly underline the major benefit patients with locally advanced disease draw from hyperfractionation and the need for an adequate selection of time-dose factors to optimize therapeutic index for accelerated regimens. In addition, the advent of high-precision techniques such as intensity-modulated radiation therapy is bound to favor the development of more intensive regimens of irradiation in the management of locally advanced head and neck squamous cell carcinomas.

Summary: Altered fractionation, both as stand-alone strategy or as part of approaches combining radiation to systemic treatments, is offering a lot of opportunities to the radiation oncologist. Its role is likely to gain ground in all high-risk patients not amenable to systemic treatments, or for whom the high toxicity of chemotherapy is not justified, in case, for instance, of intermediate-risk disease.