How do you apply hyperfractionated RT in the dose painting IMRT era in head and neck cancers?  

I prefer to use the DAHANCA approach (Overgaard J et al, Lancet Oncol 2010) of providing 6 fractions weekly, 2 Gy per fraction, with a second fraction on a Fri (at 6 hours apart). This is an accelerated course delivering 72 Gy to the primary PTV over 6 weeks. Compared with other fractionated regime...

We have not adapted hyperfractionation (HFX) for non-chemotherapy patients with intermediate to advanced disease. I infer from the question that the concern with HFX is if treatment is in 68 fractions, what dose should be given to subclinical targets. I don't think anyone knows, and the simpler solu...

At our facility, we also use @Avraham Eisbruch's approach of BID on Friday and target only the PTV1 in the afternoon. This strategy was learned from a pair of Danish H&N radiation oncologists I met at a conference in 2009. Not only did they take care of patients in Denmark, but they also practic...