A Multicentre Retrospective Cohort Study of Hypofractionated Radiotherapy in Head and Neck Cancer

Many squamous cell carcinomas of the head and neck (HNSCC) can be cured with radical radiotherapy, but conventional fractionation schedules over 6-7 weeks can be difficult to tolerate. Since the COVID-19 pandemic, and recent HYPNO trial results, interest in hypofractionation (55 Gy in 20#s) has increased, but real-world efficacy and toxicity data are limited. We evaluated the use of hypofractionation across two U.K. centres since adoption of volumetric-modulated arc therapy (VMAT).

Electronic healthcare record searches identified patients with HNSCC referred for 55 Gy in 20#s as the first definitive treatment, excluding early glottic cancers. Toxicity data were captured using the Radiation Therapy Oncology Group (RTOG) criteria at end of treatment and 4 weeks post-treatment. Time to gastrostomy removal, complete response rates, overall and recurrence-free survival were calculated.

119 patients were referred between January 2018 and August 2025, of whom 113 (95%) completed treatment. Sixty-seven (57%) had an ACE score of ≥2, and 43 (37%) had a performance status of ≥2. Most patients (76%) received treatment to the primary and bilateral neck. At end of treatment, 72 (64%) had G3 mucositis, 51 (45%) had G2 dysphagia, 43 (38%) had G2 skin toxicity, and 70 (62%) had G2 salivary toxicity. Fifty-four (45%) had gastrostomy tubes, 19 of which (35%) were removed within three months of completion. For early p16+ve oropharyngeal cancers, complete response rates were 90%, with 3-year overall survival (OS) rates of 85%.

Hypofractionation can be given safely with comparable toxicity to normofractionation outside of early glottic cancers.