From the Guidelines
The standard radiation dose for curative treatment of head and neck cancer is 70 Gy over 7 weeks, delivered to gross primary and nodal disease in patients with stage III-IV disease, as recommended by the most recent and highest quality study 1. This dose is often administered using intensity-modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT) to maximize tumor coverage while sparing nearby critical structures.
- For definitive (non-surgical) treatment, doses of 70 Gy are common, as stated in the study 1.
- Post-operative radiation typically uses 60-66 Gy, as mentioned in the study 1.
- Concurrent chemotherapy, often with cisplatin (100 mg/m² every 3 weeks or 40 mg/m² weekly), is frequently added for locally advanced disease to enhance radiosensitivity and improve outcomes, as discussed in the study 1. The high dose is necessary to overcome tumor radioresistance and achieve local control, as head and neck cancers require sufficient radiation to destroy cancer stem cells and hypoxic tumor regions.
- Treatment planning must carefully balance curative intent with minimizing toxicity to adjacent structures like the salivary glands, spinal cord, and oral mucosa, as emphasized in the study 1.
- Altered fractionation may be used in patients with stage IVA-IVB OPSCC treated with definitive radiotherapy who are not receiving concurrent systemic therapy, as recommended in the study 1.
From the Research
Radiation Dose for Curative Treatment of Head and Neck Cancer
- The radiation dose for curative treatment of head and neck cancer can vary depending on the specific treatment regimen and patient population 2, 3.
- One study reported a regimen of 76 Gy in 5 weeks for definitive head and neck cancer patients, and 65 Gy in 5 weeks for high-risk postoperative patients 2.
- Another study presented a framework for estimating a personalized RT dose for individual patients, with estimated doses ranging from 8 to 186 Gy 3.
- A different study used a dose of 70 Gy for treatment of advanced head and neck cancer, with concurrent chemotherapy using gemcitabine and cisplatin 4.
Comparison of Different Treatment Regimens
- A study compared the predicted tumor cell kill of a hyperfractionated, accelerated radiotherapy regimen (HARDE) to that of conventional fractionation (CF), and found a predicted increase in log cell kill of 1.5 and 1.3 logs, respectively, in the definitive and postoperative settings 2.
- Another study compared the results of an in silico trial of a dynamics-adapted radiotherapy dose (DARD) to standard of care radiotherapy doses, and found that 77% of patients treated with standard of care were overdosed by an average dose of 39 Gy, and 23% underdosed by an average dose of 32 Gy 3.
Toxicity and Outcome Analysis
- A study analyzed the toxicity and outcome of patients with recurrent head and neck cancer treated with hyperfractionated split-course reirradiation and concurrent cisplatin and paclitaxel chemotherapy, and found that acute grade 3 to 4 toxicity included neutropenia, nausea, emesis, and mucositis 5.
- Another study found that grade 3-4 adverse events included mucositis (46.4%), leucopenia (14.2%), dysphagia (25%), xerostomy (10.7%), and radiodermitis (3.6%) 4.