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

AIMS: 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). MATERIALS AND METHODS: 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. RESULTS: 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%. CONCLUSION: Hypofractionation can be given safely with comparable toxicity to normofractionation outside of early glottic cancers.