Multicentric Cross-Sectional Survey to Assess the Variation of Fractionation Strategies Used in the Management of Head and Neck Cancers in the Asian Region (INNOCENCE-ASIA)

Gandhi AK 1 , Chopra S 2 , Rastogi M 1 , Mallick I 3 , Cruz MC 4 , Yasuda K 5 Show all authors , Sum YY 6 , Nagata Y 7 , Wu HG 8 , Prajogi GB 9 , Kodrat H 9 , Ma M 10 , Nisar A 11 , Chitapanarux I 12

Affiliations 

  • 1 Department of Radiation Oncology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
  • 2 Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
  • 3 Department of Radiation Oncology, Tata Medical Center, Kolkata, India
  • 4 Central Luzon Integrated Oncology Center and Cancer Institute Sacred Heart Medical Center, Pampanga, Philippines
  • 5 Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan
  • 6 Department of Radiotherapy and Oncology, Penang General Hospital, George Town, Malaysia
  • 7 Department of Radiation Oncology, Chugoku Rosai Hospital, Emeritus Professor, Hiroshima University, Kure, Japan
  • 8 Department of Radiation Oncology, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, South Korea
  • 9 Department of Radiation Oncology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • 10 Department of Radiation Oncology, Peking University First Hospital, Beijing, China
  • 11 Clinical and Radiation Oncologist, AECH NORI, Islamabad, Pakistan
  • 12 Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
JCO Glob Oncol, 2025 Jan;11:e2400349.
PMID: 39819125 DOI: 10.1200/GO-24-00349

Abstract

PURPOSE: Head and neck cancers (HNCs) are in general treated with conventional fractionation regimen of 1.8-2 Gy per fraction. Altered fractionation (ALFT) strategies such as hypofractionation radiotherapy (HYPO-RT), accelerated fractionation radiotherapy (AFRT), and hyperfractionation radiotherapy (HFRT) have not been practiced uniformly across centers in different parts of the world. Countries in Asia share common cancer demographics, and we designed this survey for Federation of Asian Radiation Oncology (FARO) member countries to understand the usage and challenges in the delivery of ALFT in HNCs.

MATERIALS AND METHODS: A 21-point electronic survey (Federation of Asian Radiation Oncology Research Network [FERN]-S-005) was designed by the FERN and was circulated through the FARO research secretariat to the FARO council member countries and the responses were collected between August and November 2023.

RESULTS: Twelve of 14 member countries (85.7%) responded to the survey. Twenty-seven responses were received and 78% of the respondents belonged to government/teaching academic institute. 4/27 (14.8%) reported never using HYPO-RT for any of the clinical subsite of HNCs, while the majority (85.2%) used it for glottic cancers and 22% also used it for postoperative setting. Majority (77.7%) used a fractionation schedule with dose per fraction ranging between 2.2 and 2.5 Gy. 6/27 (22.2%) used AFRT for definitive setting and five of these also used concurrent chemoradiotherapy. 4/27 (14.8%) centers reported using HFRT. The most common reason (62.9%) for the limited usage of AFRT/HFRT was reported to be logistical, such as unavailability of machine slots, patient load, and so on.

CONCLUSION: The result of the survey suggests that among the ALFT strategies for HNCs, HYPO-RT schedules have common interest and feasibility among the FARO member countries and also highlights the challenges in the delivery of AFRT/HFRT in the Asian region.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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