Hypofractionated radiotherapy denoted as the “Christie scheme”: An effective means of palliating patients with head and neck cancers not suitable for curative treatment

Figures & data

Table I.  Patients, tumor, and treatment characteristics.

	No. of patients (%)
Gender
Male	116 (74%)
Female	42 (26%)
Age (years)
Range	41–95
Median	68.5
Follow-up (months)
Range	1–122
Median	16.4
Tumor site
Oropharynx	50 (31%)
Oral cavity	36 (23%)
Hypopharynx	36 (23%)
Larynx	31 (20%)
Nasopharynx	3 (2%)
Nasal cavity and PNS	2 (1%)
Tumor stage
I	10 (6%)
II	7 (5%)
III	13 (8%)
IVA	66 (42%)
IVB	47 (30%)
IVC	15 (9%)
Indication Christie scheme
Poor performance status	25 (16%)
Massive tumor	23 (14%)
Metastatic disease	15 (9%)
Second or third primary	11 (7%)
Synchronous tumor elsewhere	10 (6%)
Synchronous HN tumor	5 (3%)
High age	4 (3%)
Combination of factors	61 (39%)
Reason not mentioned	4 (3%)
Radiotherapy scheme
5 times a week	81 (51%)
4 times a week	77 (49%)

Table II.  Disease by site and stage.

	I + II	III	IVA	IVB	IVC	Total
Oropharynx	0	5	26	15	4	50
Oral cavity	0	3	15	15	3	36
Hypopharynx	3	2	16	10	5	36
Larynx	14	3	7	7	0	31
Nasopharynx	0	0	1	0	2	3
Nose and Nasal cavity	0	0	1	0	1	2
Total	17	13	66	47	15	158

Table III.  TNM staging of tumor.

	T1	T2	T3	T4	Total
N0	8	7	9	22	46
N1	3	1	3	11	18
N2	3	4	18	49	74
N3	2	4	7	7	20
Total	16	16	37	89	158

Figure 1.  Kaplan-Meier curve of local regional control.

Table IV.  Overall response rates, disease-free survival and overall survival at 1-year.

Site	Stage	Number	ORR%	p-value	1Y-DFS%	p-value	1Y-OS%	p-value
All sites	All stages	158	73%		32%		40%
	I/II	17	94%		61%		61%
	III/IVA/IVB	126	71%		33%		38%
	IVC	15	60%		13%		27%
				0.02		0.005		0.04
Larynx	All stages	31	91%		56%		56%
Oropharynx	All stages	50	75%		30%		42%
Oral cavity	All stages	36	68%		25%		28%
Hypopharynx	All stages	36	61%		28%		33%
				0.04		0.02		0.08

Abbreviations: ORR: overall response rate; 1Y-DFS: 1-year disease-free survival; 1-Y OS: 1-year overall survival. Note: significant p-values (<0.05) are indicated in bold.

Figure 2.  Kaplan-Meier curve of overall and disease-free survival.

Figure 3.  Kaplan-Meier curve of disease-free survival by tumor stage.

Figure 4.  Kaplan-Meier curve of disease-free survival by tumor site.

Figure 5.  Kaplan-Meier curve of overall survival of patients with HNSCC in relation to the presence or absence of major co-morbidity.

Table V.  Chart review of patients survived ≥1 year after completing the treatment.

Items evaluated	Evaluable (n)	N (%)
Pain	13
Improved		10 (77%)
No change		2 (15%)
Worse		1 (8%)
Not reported		0%
Bad performance Status	30
Improved		14 (47%)
No change		6 (20%)
Worse		6 (20%)
Not reported		4 (13%)
Feeding-tube dependency	48
Improved		31 (65%)
No change		14 (29%)
Worse		0%
Not reported		3 (6%)
Weight loss	42
Improved		21 (50%)
No change		10 (24%)
Worse		2 (5%)
Not reported		9 (21%)

Note: Evaluable (n) means number of patients who had that specific symptom by finishing the radiotherapy. N (%) of patients who showed improvement in that specific symptom 1 year after treatment are indicated in bold

Figure 6.  Cumulative (actuarial and crude) incidences of grade ≥2 late RTOG/EORTC toxicity.