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Radiation plays an important role in the definitive treatment of various head and neck cancers. The innovations of new techniques like IMRT, IGRT , VMAT has significantly reduced toxicity profile of patients treated with radiotherapy.Most common complications which are seen during radiation include dermatitis , mucositis dysphagia, xerostomia .Though most patients recover  quality of life by 12 months, deterioration in physical functioning, fatigue, xerostomia, and sticky saliva persist beyond 12 months in head and neck cancer survivors .

Temporally Feathered Radiation Therapy (TFRT) has been proposed as a technique to reduce toxicity in patients undergoing radiation therapy to the head and neck. In IMRT we optimize the physical distribution of radiation dose, in  TFRT optimisation is done to the  time through which radiation therapy is delivered and take advantage of the non-linear recovery of normal tissues

Patients with HNSCC of oropharynx  treated with definitive radiation therapy were eligible (70 Gy in 35 fractions) were eligible. The primary endpoint was feasibility of TFRT planning as defined by radiation start within 5-7 days days of CT simulation. Secondary endpoints included estimates of acute toxicities

•    We analysed 10 patients, with a follow up period of 10 months . TFRT plans were generated for all  ten patients within one week  of CT simulation, therefore meeting the primary endpoint. For patients who received TFRT, the median time from CT simulation to radiation start was 3 business days (range 2–5). In all patients receiving TFRT, each subplan and every daily fraction was delivered in the correct sequence without error. The OARs feathered included: oral cavity, each submandibular gland, each parotid gland , and posterior pharyngeal wall (OAR pharynx), Larynx.  Prescription dose PTV coverage (>95%) was ensured in each TFRT subplan and the composite TFRT plan.

None of the patients had more than grade 3 and 4 toxicities.We compared these toxicities in TFRT IMRT plans to previously executed standard IMRT plans ( which was used as control ) and  found that in previously treated standard IMRT plans majority had grade 3 and  4 toxicities.

This study demonstrates the implementation of a new planning technique - TFRT , proving its feasibility in the modern clinical workflow. We experimented only 10 patients to see the impact of TFRT,and it has shown benefit over non TFRT plans in terms of reducing acute toxicities and also it can be easily incorporated in daily clincal workflow in the department . May be Additional prospective assessments are needed to check the complication rates.