CLINICAL INVESTIGATION Head and Neck RETROSPECTIVE STUDYOF PALLIATIVE RADIOTHERAPY IN NEWLY DIAGNOSED HEAD AND NECK CARCINOMA CHRISTIAAN M. STEVENS, M.D.,* SHAO HUI HUANG, M.R.T.(T.), M.SC.,* SHARON FUNG, M.SC., y ANDREW J. BAYLEY, M.D.,* JOHN B. CHO, M.D., PH.D.,* BERNARD J. CUMMINGS, M.B., CH.B.,* LAURA A. DAWSON, M.D.,* ANDREW J. HOPE, M.D.,* JOHN J. KIM, M.D.,* BRIAN O’SULLIVAN, M.B., B.C.H.,* JOHN N. WALDRON, M.D.,* AND JOLIE RINGASH, M.D.* *Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, and University of Toronto, Toronto, ON, Canada; y Department of Biostatistics, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada Purpose: To examine the patterns of care, outcomes, and prognostic factors for patients with head-and-neck cancer (HNC) treated with palliative radiotherapy (RT). Methods and Materials: An institutional HNC anthology and electronic patient records were used to identify pa- tients with previously untreated HNC of mucosal or salivary gland origin who underwent palliative RT at our in- stitution between July 2003 and June 2008. Overall survival was determined from the start date of RT to either the date of death or the date of last follow-up for living patients. The data were censored if the subject was either lost to follow-up or had not been seen for follow-up at our institution for $4 months. Results: We identified 148 eligible patients. The median age was 72 years (range, 19–94). Of the 148 patients, 12 had Stage II-III, 39 Stage IVA, 36 Stage IVB, and 54 Stage IVC; for 7 patients, the stage was unknown. Oropharyngeal primary cancer (40) was the most common primary site. The Eastern Cooperative Oncology Group performance status was 0 in 15, 1 in 69, 2 in 40, 3 in 19, and 4 in 5 patients. The Adult Co-morbidity Evaluation-27 scale was 0 in 33, 1 in 47, 2 in 44, and 3 in 21. The median radiation dose was 50 Gy (range, 2–70), the median fraction number was 20 (range, 1–40), and the median total treatment time (including breaks) was 29 days (range, 1–80). At analysis, 108 patients (73%) had died, 20 (13.5%) were alive, and 20 (13.5%) had been censored. The median follow-up was 4.8 months, and the median survival time was 5.2 months. Information on the treatment response was available for 103 patients (70%). On multivariate analysis, the radiation dose was an independent predictor of both overall survival (hazard ratio 0.97, 95% confidence interval 0.96–0.99, p <.01) and treatment response (odds ratio 1.05, 95% con- fidence interval 1.01–1.08, p <.01). Conclusion: For patients considered unsuitable for curative RT, the radiation dose might be an independent pre- dictive factor for both overall survival and treatment response. Additional research is required to more effectively select those patients who might benefit from more aggressive treatment. Ó 2011 Elsevier Inc. Head-and-neck cancer, palliation, radiotherapy, radiation dose, predictive factors. INTRODUCTION A proportion of patients with head-and-neck cancer (HNC) are not candidates for curative therapy because of advanced stage, poor performance status (PS), medical comorbidities, or a combination of these factors. Although the prognosis for these patients has generally been poor, given the critical importance of the tissues of the head and neck to basic life functions, palliative radiotherapy (RT) has been widely used to provide symptom relief and/or to attain locoregional disease control to pre-empt symptom development. However, significant overlap can be present between the presenting symptoms and radiation-related toxicity, making the decisions surrounding palliative RT challenging. Al- though evidence from retrospective and case-control series (1–7), single-arm prospective trials (8–14), and one small randomized controlled trial (15) have suggested that pallia- tive RT is associated with improved outcomes in these pa- tients, consensus guidelines or Level I evidence is lacking to direct the optimal choice of palliative RT regimens. As such, our institution does not have defined treatment policies regarding palliative RT for HNC. Decisions regarding RT, including dose and fractionation, target volumes, and tech- nique, are made at the discretion of the treating radiation on- cologist and are often influenced further by patient-related Reprint requests to: Jolie Ringash, M.Sc., M.D., Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, and University of Toronto, 5th Fl., Rm. 900, 610 Univer- sity Ave., Toronto, ON M5G 2M9 Canada. Tel: (416) 946-4662; Fax: (416) 946-2111; E-mail: jolie.ringash@rmp.uhn.on.ca Presented, in part, at the 51st American Society of Therapeutic Radiology and Oncology, Chicago, IL, November 1–5, 2009. Conflict of interest: none. Received April 1, 2010, and in revised form June 10, 2010. Accepted for publication June 21, 2010. 958 Int. J. Radiation Oncology Biol. Phys., Vol. 81, No. 4, pp. 958–963, 2011 Copyright Ó 2011 Elsevier Inc. Printed in the USA. All rights reserved 0360-3016/$–see front matter doi:10.1016/j.ijrobp.2010.06.055