Top Line: Some patients with locally-advanced head and neck cancer cannot feasibly or reliably present for 7 weeks of daily treatment or have other reasons to require an expedited completion of treatment.
The Study: Initial abstract reporting of the HYPNO trial at ASTRO 2023 suggested 55 Gy in 20 fractions resulted in non-inferior locoregional control and grade 3 mucositis at 3 years compared to conventional fractionation. The most common subsite was oropharynx (51%), and 75% received concurrent chemotherapy. Today we bring you the full manuscript with identical reporting of coprimary endpoints—3-year loco-regional control was 51% regardless of fractionation and grade 3+ late adverse events 19-20%—both easily meeting dual noninferiority (Δ < 10%). Reported 3-year overall survival remains 54.1% after hypofractionation versus 55.5% after conventional fractionation. Of note, the proportion of patients whose total treatment time was extended by more than 5 days due to unplanned breaks was to no surprise significantly less in the hypofractionation arm (10% v 18%). We do get some more details on early toxicity, which is where we may expect to see more discrepancy than in tumor control. Interestingly, while acute rates of mucositis and dysphagia were similar, there was significantly less grade 3 dermatitis (9% vs 22%) and >10% weight loss (29% v 42%) with hypofractionation, though this could be due to peak acute toxicity occurring after completion of treatment at a time not monitored in clinic.
TBL: Full reporting of HYPNO shows non-inferior locoregional control and late grade 3+ toxicity with moderate hypofractionation for locally advanced head and neck cancer. | Bentzen, Int J Radiat Oncol Biol Phys 2026
The Study: Initial abstract reporting of the HYPNO trial at ASTRO 2023 suggested 55 Gy in 20 fractions resulted in non-inferior locoregional control and grade 3 mucositis at 3 years compared to conventional fractionation. The most common subsite was oropharynx (51%), and 75% received concurrent chemotherapy. Today we bring you the full manuscript with identical reporting of coprimary endpoints—3-year loco-regional control was 51% regardless of fractionation and grade 3+ late adverse events 19-20%—both easily meeting dual noninferiority (Δ < 10%). Reported 3-year overall survival remains 54.1% after hypofractionation versus 55.5% after conventional fractionation. Of note, the proportion of patients whose total treatment time was extended by more than 5 days due to unplanned breaks was to no surprise significantly less in the hypofractionation arm (10% v 18%). We do get some more details on early toxicity, which is where we may expect to see more discrepancy than in tumor control. Interestingly, while acute rates of mucositis and dysphagia were similar, there was significantly less grade 3 dermatitis (9% vs 22%) and >10% weight loss (29% v 42%) with hypofractionation, though this could be due to peak acute toxicity occurring after completion of treatment at a time not monitored in clinic.
TBL: Full reporting of HYPNO shows non-inferior locoregional control and late grade 3+ toxicity with moderate hypofractionation for locally advanced head and neck cancer. | Bentzen, Int J Radiat Oncol Biol Phys 2026