Role of addition of chemotherapy to palliative radiotherapy protocol: A review of literature and experience from a tertiary cancer center of India

Abstract

Unresectable head-and-neck cancers (HNCs) pose a significant challenge to clinical oncologists. Radiotherapy (RT) has a pivotal role in palliation of symptoms in advanced unresectable stage. Palliative RT protocols generally employ hypofractionated regimes in an attempt to reduce the overall treatment time and acute toxicities. Concurrent chemoradiotherapy (CCRT) may improve local control facilitating faster palliation of symptoms. Yet the role of chemotherapy with hypofractionated schedules is unclear in palliative settings due to the fear of increased toxicities. The literature review was hence conducted to validate the tolerability and efficacy of CCRT in the palliative setting. The literature search was performed on electronic databases using appropriate keywords. Studies evaluating untreated patients, treated recurrent cancers, second primaries localized in the head and neck or metastatic HNC were all chosen. Five studies were selected which met our selection criteria. Palliation of symptoms, response rates, and toxicities of these studies was evaluated. Role of such concurrent regimes at other sites have also been discussed. All the evaluated studies demonstrated good rates of symptom palliation and response rates with tolerable adverse effects. In addition, our literature review has identified a paucity of evidence that warrants large-scale longitudinal studies to derive conclusive remarks on the use of palliative CCRT.