A Prospective Single-arm Cohort Study Assessing the Rate of Radical Conversion following Palliative Radiation in Locally Advanced Head and Neck Cancer Cases Deemed Incurable

A BSTRACT Background: Patients with locally advanced head and neck squamous cell carcinoma (LAHNC) who are considered unsuitable for definitive therapy are commonly managed with palliative intent. However, a subset of patients may demonstrate significant tumor regression following short-course palliative radiotherapy (Pal RT), allowing subsequent radical treatment. This study aimed to evaluate the rate of radical conversion following initial Pal RT using 30 Gy in 10 fractions in patients with initially incurable LAHNC. Materials and Methods: This prospective, longitudinal, single-arm cohort study was conducted in a tertiary care teaching hospital in West Bengal, India, between June 2023 and May 2024. Sixty patients with histopathologically confirmed LAHNC deemed unsuitable for radical therapy because of poor performance status, comorbidities, or extensive disease burden were enrolled. All patients received Pal RT to a dose of 30 Gy in 10 fractions over 2 weeks. Treatment response was assessed 2 weeks after completion of Pal RT using RECIST version 1.1 criteria. Patients achieving complete or partial response (PR) underwent radical radiotherapy (Rad RT) to a cumulative dose of 70 Gy. Symptom relief, treatment-related toxicities, and overall survival were analyzed. Results: PR following Pal RT was observed in 43 patients (71.7%), while stable disease and progressive disease were noted in 23.3% and 5% of patients, respectively. No complete response (CR) was observed after Pal RT. All patients achieving PR subsequently underwent radical conversion. Following Rad RT, CR was achieved in 48.8% of patients and PR in 41.9%, with no cases of progressive disease. Significant symptom palliation was observed, particularly for bleeding (92.3%), pain (70.2%), and dysphagia (60%). No treatment-related mortality occurred. Acute toxicities following Pal RT were predominantly Grade 1 dermatitis and mucositis, while expected Grade 2–3 toxicities were observed after radical treatment. Median overall survival was 8 months in the Pal RT-only group, whereas median survival was not reached in the Rad RT group. Kaplan–Meier analysis demonstrated significantly improved survival among patients undergoing radical conversion (log-rank P < 0.001). Conclusion: Hypofractionated Pal RT with 30 Gy in 10 fractions is an effective and feasible strategy for patients with initially incurable LAHNC. In addition to providing meaningful symptom palliation, this response-adaptive approach identifies favorable responders who may benefit from subsequent radical treatment, resulting in improved survival outcomes.