Hypofractionated Radiotherapy for HNSCC in Elderly Patients

Inclusion Criteria:

1. Age ≥ 65 years;
2. Patients with histologically or cytologically confirmed stage II-IVA head and neck squamous cell carcinoma (AJCC 8th edition), including oral cavity, oropharynx, hypopharynx, larynx, and cervical metastatic squamous carcinoma of unknown primary;
3. At least one measurable lesion;
4. No prior systemic antitumor treatment or locoregional therapy for head and neck squamous cell carcinoma;
5. ECOG performance status of 1-3;
6. Expected survival time of ≥ 3 months;
7. Patients assessed by the physician as unsuitable for surgical treatment and not candidates for radical radiotherapy;
8. Functional status of vital organs compatible with daily basic activities (excluding any blood components or cell growth factors within 14 days): adequate bone marrow reserve function: white blood cells (WBC) ≥ 2.0 × 10\^9/L, neutrophil count (NEUT) ≥ 1.0 × 10\^9/L, platelet count (PLT) ≥ 80 × 10\^9/L, hemoglobin (Hb) ≥ 90 g/L;
9. Able and willing to comply with the study and follow-up procedures;
10. The subject voluntarily agrees to participate in this clinical study and signs the informed consent form, demonstrating good compliance and ability to cooperate with follow-up.

Exclusion Criteria:

1. Previously undergone radiotherapy for head and neck cancer;
2. Squamous cell carcinoma of other primary sites in the head and neck, such as paranasal sinuses, nasopharynx, glottic laryngeal cancer, skin, or salivary gland tissues;
3. Concurrent other antitumor therapies;
4. Neoadjuvant therapy;
5. Subjects who have experienced a severe infection within one month before enrollment, including but not limited to infections requiring hospitalization, bacteremia, severe pneumonia, etc.;
6. Subjects with any active infection or unexplained fever \> 38.5°C occurring during the screening period or before the first dose;
7. Presence of severe cardiovascular diseases: Grade II or higher myocardial ischemia or myocardial infarction, poorly controlled arrhythmias (including QTc interval male ≥ 450 ms, female ≥ 470 ms); NYHA Class III-IV heart failure (according to the New York Heart Association classification, see Appendix 3), or echocardiogram indicating left ventricular ejection fraction (LVEF) \< 50%;
8. History of other malignancies within the past five years (except for completely treated in situ cervical cancer or basal cell carcinoma or squamous cell carcinoma of the skin);
9. History of substance abuse involving psychiatric drugs that cannot be discontinued or presence of mental disorders.