Grant: Project Grant

Head and neck squamous cell carcinoma (HNC) that arises within the aerodigestive tract or the skin of the face/scalp affects many patients. Like most cancers, HNC incidence increases with age. Curative treatment strategies for HNC often include radiotherapy (RT) treatment given daily for 6-7 weeks. Patients with HNC who are not suitable candidates for this treatment due to concerns about side effects or other age-related health conditions but who have tumours large enough to cause symptoms such as pain, difficulty chewing/swallowing or bleeding (known as advanced (A)HNC) are usually offered a lower dose of palliative RT given over a shorter time period to control tumour growth. Invariably these tumours progress and are lethal. Better treatments for these patients are urgently needed. Advances in RT planning and delivery have resulted in a new technique called stereotactic body radiation therapy (SBRT). This technique allows higher doses of radiation to be directed to the tumour while sparing normal tissue compared to standard palliative RT. SBRT is being used in different treatment settings such as in early lung cancer to improve tumour control and in patients with cancer that has spread to the spine to improve pain control. With respect to HNC, data from a Canadian institution demonstrate that SBRT can be administered safely with potentially better tumour control and survival rates in AHNC patients compared to the standard palliative RT. We propose comparing SBRT versus standard palliative RT in patients with AHNC who are unsuitable for treatment with curative intent RT in a prospective randomized phase III trial. If the trial results are positive, SBRT will be considered a treatment option for patients with AHNC to improve survival and other disease-related symptoms. With better survival and symptom control, SBRT for AHNC has the potential to reduce the burden of care on the healthcare system.