Is there an optimal palliative dose for head and neck cancer? In the randomized, phase 3 OpRAH trial, 305 patients with locally advanced HNSCC who were not suitable for curative intent treatment were randomized to received either 30 Gy or 20 Gy in 5 daily fractions to gross disease plus a 5mm PTV margin. Dose-escalation did not significantly improved medial PFS (7.17 v 7.6 months). Grade 2 toxicity was 11.2% with 20 Gy and 19.6% with 30 Gy. Most patients progressed locoregionally (76.5% with 20 Gy v 63.7% with 30 Gy) Performance status was the only factor significantly associated with survival outcomes. This begs the question of whether a 5-fraction regimen provides adequate palliation except in those with the poorest prognosis? | Mallick, Radiother Oncol 2024
