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.