Resource Sparing Curative Radiotherapy for Locally Advanced Squamous Cell Cancer of the Head and Neck

Worldwide, head and neck squamous cell carcinomas (HNSCC) (1) comprise approximately 7% of all incident cancers, and of these 64% are seen in low and middle income countries (13). Life-style factors, in particular tobacco and alcohol consumption, are major etiological factors, although an increasing number of HNSCC cases are associated with viral infections (Epstein Barr Virus and Human Papillomavirus) (1). Radiation therapy (RT) alone or combined with cytotoxic or molecular targeted agents is a mainstream definitive treatment for previously untreated locally advanced disease. This therapy offers organ and functional preservation in many cases with an approximate 30-50% of cases obtaining long-term loco-regional tumour control.

Accelerated RT, that is increasing the dose above the standard 10 Gy per week, has been shown in a large number of randomized controlled trials to be associated with an improved efficacy/toxicity ratio relative to standard fractionation, provided a careful balance between total dose, dose per fraction and overall treatment time is chosen. The attractive feature of this approach is that the total treatment time is shorter than the conventional treatment (4 vs. 7 weeks in this case), thus being convenient for the patient, and the department can increase 75% the number of treated patients with the same workload.

By optimizing fractionation of radiotherapy in a resource sparing combined modality approach, it is expected that Member States will benefit from the rational use of existing equipment and staff levels, decreasing costs, yet providing optimal treatment for patients. This CRP continues Agency’s research efforts which have improved the clinical practice in radiotherapy of locally advanced HNSCC cancer.