What is a safe and effective dose and fractionation for palliating head and neck cancer?  

I agree with aggressive treatment in patients with a good performance status. For those with a poor PS or with multiple comorbidities, we've used the QUAD SHOT regimen- 14Gy over 4 fractions in 2 days, repeated every 4 weeks up to a dose of 42Gy/12 fractions, if tolerated. This fractionation gives a...

20 Gy in two fractions with a 1 week interfraction interval unless it's advanced larynx/pyriform sinus without a trach where I would be concerned about the airway. Also 20 Gy in 5 fractions or 30 Gy in 10 fractions. 50 Gy in 20 fractions if life expectancy is not too limited.

The problem with "an answer" is there are so many variables: size and location of primary and nodes; goal - is local control possible or is it staunching bleeding and dampening odor from necrotic primary/nodes?; can you really forecast duration of survival?; most importantly, patient expectation - -...

Many responders have commented on Quad Shot. I'd like to add to the discussion by drawing attention to the experience at Beth Israel. We treated patients with Quad Shot fraction with the addition of radiosensitizing carboplatin. Carbo AUC2 was administered on day 1 of each "cycle." Compared to data ...

I tend to use the 50 Gy in 20 fractions with a planned week break (Princess Margaret regimen). I have seen very good local control with this regimen, and it seems to be less taxing on patients than the standard 7 week course. If the life expectancy is short, I like 40 in ten as well. Though, if ther...

Depending on life expectancy and extent of head and neck disease, the head and neck attending at my institution will treat 400 cGy x 10 fractions for palliative treatment. Patients tend to tolerate this well with regard to acute toxicities and he argues that better local control spares them from a p...

We tend to treat to curative doses (70Gy in 35fx) with chemo even with stage IV disease. You have one good shot at local control. As mentioned above local failure of a head and neck primary can result in very bad quality of life. If the person has a very poor performance status to begin with, then i...

If this patient's metastatic NSCLC predicts for an OS of less than 6 months I would go with the Louisville regimen of 14 Gy in 4 fractions over two days.  If the predicted OS is greater (12 months let's say due to oligometastatic disease treated by SBRT) I'd prolong the treatment course along t...

For advanced HN cancer with a limited life expectancy, I use 0-7-21 regimen from PMH.

We use 20Gy/5F with 1 week break then repeat or 370cGyBIDx4F for three weekly courses. We choose based on on the patient's schedule. The data (and my experience) are that you can expect local control for a few months and survival of about 6 months. If the patient can do more and wants to do more we ...