Goals of care.
Palliative radiation for advanced head and neck cancer is often not as straightforward as palliation at other sites. On one hand, locoregional disease progression can have high morbidity--but so can aggressive radiation to mucosal sites. Here’s a great review of various palliative radiation regimens and their supporting data in both the de novo and re-irradiation settings. A broad range of regimens can be considered, but it’s important to choose a regimen (or none at all) based on the needs of the patient. For those with limited prognosis but in need of short-term symptom control, short courses where fractions are split over time (such as our personal favorite - the QUAD shot regimen) provided good responses with limited toxicity and the ability to reassess the patient after brief treatment breaks. On the other hand, more prolonged courses up to and including a full 35 fractions can be appropriate for select patients (as we’ve recently seen with nasopharyngeal carcinoma). TBL: A broad range of radiation regimens are available to balance tumor control, symptom control, and toxicity for patients with advanced head and neck cancer. | Grewal, Int J Radiat Oncol Biol Phys 2020