Resource Sparing Curative Radiotherapy for Locally Advanced Squamous Cell Cancer of the Head and Neck

Closed for proposals

Project Type

Coordinated Research Project

Project Code




Approved Date

2 September 2010


Active - Ongoing

Start Date

15 November 2010

Expected End Date

14 May 2022

Completed Date

16 June 2023

Participating Countries

South Africa


Worldwide, head and neck squamous cell carcinomas (HNSCC) (1) comprise approximately 7% of all incident cancers, and of these 64% are seen in low and middle income countries (13). Life-style factors, in particular tobacco and alcohol consumption, are major etiological factors, although an increasing number of HNSCC cases are associated with viral infections (Epstein Barr Virus and Human Papillomavirus) (1). Radiation therapy (RT) alone or combined with cytotoxic or molecular targeted agents is a mainstream definitive treatment for previously untreated locally advanced disease. This therapy offers organ and functional preservation in many cases with an approximate 30-50% of cases obtaining long-term loco-regional tumour control.

Accelerated RT, that is increasing the dose above the standard 10 Gy per week, has been shown in a large number of randomized controlled trials to be associated with an improved efficacy/toxicity ratio relative to standard fractionation, provided a careful balance between total dose, dose per fraction and overall treatment time is chosen. The attractive feature of this approach is that the total treatment time is shorter than the conventional treatment (4 vs. 7 weeks in this case), thus being convenient for the patient, and the department can increase 75% the number of treated patients with the same workload.

By optimizing fractionation of radiotherapy in a resource sparing combined modality approach, it is expected that Member States will benefit from the rational use of existing equipment and staff levels, decreasing costs, yet providing optimal treatment for patients. This CRP continues Agency’s research efforts which have improved the clinical practice in radiotherapy of locally advanced HNSCC cancer.


To improve policies in MS concerning radiotherapy and cancer treatment for HNSCC, and ensuring effective and efficient utilization of current and future advanced cancer radiotherapy treatment technologies.

Specific objectives

To run a clinical trial to test a resource sparing fractionation regime to treat HNSCC (66 Gy given in 33 fractions (6 fractions per week) vs. 55 Gy given in 20 fractions (5 fractions per week).

To support at least two PhD students from developing countries, who will conduct radiobiological translational research studies

The protocol addresses an important topic in applied radiobiology: ie the optimal strategy to balance the potential gain in efficacy of treatment achievable by limiting tumour repopulation during radical head and neck radiotherapy with the decrease in overall dose required with hypofractionation to maintain equipoise in normal tissue toxicity. Data generated from this trial will provide information on the extent and timing of repopulation and the parameters for normal tissue repair processes. As such, the trial has potential for impact in radical radiotherapy beyond the field of head and neck oncology.

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