Session Item

To assess efficacy and toxicity of two split course fractionation schedules in elderly and frail patients with advanced head and neck cancers.

From January 2018 to May 2021, 105 patients, including 43 women and 62 men, were qualified and treated. Sixty-seven patients were older than 70 years, the remainder had numerous comorbidities.  The clinical advancement stage II was found in 25 patients, stage III in 33 patients, and in the remaining 47 patients - stage IV. Two fractionation schedules were used. Both consisted of two courses with a three-week break. In the first one SIB technique was used – patients received 45Gy at 4,5Gy per fraction to tumor volume and 40Gy at 4Gy per fraction to elective volume. The second was used in more advanced cases. Patients received 44Gy at 4Gy per fraction to the whole volume. Patients over 70 years of age were assessed according to the G8 scale.

The mean follow-up time was 8.2 months. Seven patients were lost from follow-up. In the group of patients assessed according to the G8 questionnaire, 82% of patients received a score equal to or lower than 14 points.  CR was observed in 50.5% of patients. In the group treated according to the SIB schedule, the CR percentage was 60.6%, and for the second regimen it was 33.3%. Two patients had local recurrence. Toxicity in both groups was similar. At the end of each course, patients developed mainly G1 skin toxicity and G2 on mucous membranes according to the EORTC / RTOG scale. There was no need to postpone or abandon the second course in any of the patients. 

Both regimens show promising efficacy with good tolerance and could represent an alternative to palliative strategies in elderly and frail patients.