Palliative radiotherapy in advanced head and neck cancers: A pragmatic experience from a high volume tertiary care centre

Objectives: The study aims to evaluate the clinical efficacy, toxicity profile, radiobiological implications, and tumour response of four commonly used palliative hypofractionated regimens in this setting. Material and Methods: Retrospective analysis was conducted on 102 patients treated with one of four regimens: 20 Gy/5# daily, 20 Gy/5# weekly, 30 Gy/10# daily, or 50 Gy/16#. Biologically effective dose (BED) and equivalent dose in 2 Gy fractions (EQD2) values were calculated using the linear-quadratic model. Outcomes included symptom relief, tumour response, toxicity, and follow-up. Results: Most patients were male (90.2%), with a mean age of 53.5 years. Oral cavity (53.9%) and larynx (24.5%) were the predominant sites. Patients receiving 50 Gy/16# achieved the highest tumour response (95%) and best symptom relief (100% for pain and dysphagia) but had the highest toxicity and treatment interruptions (85%). The 30 Gy/10# regimen demonstrated comparable tumour response (84%) with significantly fewer toxicities and a median follow-up of 10.5 months. The 20 Gy/5# daily regimen provided moderate symptom relief (70–78%), minimal toxicity, and the fewest treatment interruptions with a median follow-up of 9.4 months. The 20 Gy/5# weekly regimen was well tolerated but yielded the lowest response rates across all parameters (pain relief 50%, hoarseness 33%, bleeding control 40%). Conclusion: In a high-volume Indian tertiary care centre setting, 30 Gy/10# offers an excellent balance of symptom control and tolerability. Higher-dose regimen with 50 Gy/16# should be reserved for fit patients with longer life expectancy. The 20 Gy/5# daily regimen remains a practical and low-toxicity choice for frail patients, while the weekly regimen may be reserved for the most unfit. These findings underscore the need for individualized, context-sensitive palliative strategies based on patient fitness, expected survival, and institutional workload.