KEY POINTS
- This two-center UK retrospective cohort included 119 patients receiving definitive 55 Gy in 20 fractions between 2018 and 2025, excluding early glottic cancer. Mean age was 72 years, 57% had an Adult Comorbidity Evaluation score ≥2 and 37% had performance status ≥2.
- Treatment used VMAT, with elective nodal regions receiving 44 Gy in 20 fractions when indicated. Most patients (76%) received treatment to the primary tumor and bilateral neck; concurrent chemotherapy was not routinely used and only one historical patient received platinum.
- Treatment completion was high despite the frail population: 113/119 patients (95%) completed all planned fractions. Four of the six discontinuations were caused by toxicity, one by rapid cancer progression and one by non-compliance.
- Acute toxicity remained substantial. At treatment completion, 64% had grade 3 mucositis, 39% grade 3 dysphagia, 38% grade 2 skin toxicity and 62% grade 2 salivary toxicity; four weeks later, grade 3 mucositis had fallen to 26% and grade 3 dysphagia to 21%.
- Gastrostomy tubes were used in 54 patients (45%), most prophylactically. Nineteen tubes (35%) were removed within three months, whereas 8/54 patients (15%) remained tube-dependent for at least 12 months and another 15 died within 12 months with the tube still in place.
- Overall complete response among treatment completers was 67%. In evaluable p16-positive oropharyngeal disease, complete response was 86%; among early-stage p16-positive tumors it reached 90%, with three-year overall survival 85% and recurrence-free survival 78%.
- Across the whole heterogeneous cohort, one-, two- and three-year overall survival was 76%, 60% and 44%. Stage and comorbidity independently predicted survival, while interpretation by tumor subsite is limited by small numbers, retrospective toxicity scoring and sparse late-toxicity assessment beyond gastrostomy dependence.
CLINICAL TAKEAWAY
A four-week 55-Gy/20-fraction course can deliver radical treatment to selected older or comorbid head and neck patients who may struggle with conventional six- to seven-week schedules. Acute mucosal toxicity remains considerable, and because this cohort has no contemporary control group, the study supports feasibility and selection rather than proving equivalence on its own.