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The aim of this study was to evaluate survival rates as well as acute and late toxicity after hypofractionated palliative radiotherapy (RT) in patients (pts) with low performance status and elderly patients, unfit of standard RT treatment.

Between December  2010 and June 2020, 211 pts underwent hypofractionated palliative RT treatment were evaluated retrospectively. The prescribed dose was 36,75 - 42 Gy in 7-8 fractions given one fraction of 5,25 Gy weekly. Of them 104 pts (49,3%) were male and 107 (50,7%) female. Mean age was 79 years old (range 42-100 years). Majority of pts were elderly with 2 or more comorbidity (88 % pts were aged more than 70 years old). The primary treated consisted in head and neck cancer (31 %), lung cancer (19 %), gynecological cancer (17 %), gastrointestinal cancer (8 %), breast cancer (7 %), prostate cancer (7%), skin cancer (7 %), sarcomas (2 %) and other metastatic disease (2 %). 

A 3DCRT technique was used in 88 (pts)  (41,7 %) and a VMAT or IMRT technique in 123 (pts)  (58,3 %). Concomitant systemic chemotherapy (OT, CT or immunotherapy) was administered in only 41 pts (19,4 %). At the moment of RT start the median KPS was 70 (range 40-90).

After a mean follow-up of 14 months the median overall survival was 11 months. Overall, 74,5 % of patients completed radiotherapy at the prescribed dose and 25,5 % interrupt it due to PD, clinical worsening or lost motivation

A clinical or radiological examination response was observed in 56 % of patients; CR 24 %, PR 32 %.

A SD was obtained in 6 %, a PD 17 % of pts and in reaming 21 % was not possible to evaluate the response. In pts receiving the prescribed the response rate was 75 %, of them 35 % had a CR. Patients that completed RT treatment at the prescribed (RT 36,75 Gy-42 Gy in 7-8 ff) had a higher survival rate compared to patients which interrupt RT treatment (median 14 mths vs 3 mths; p-value 0,0001). Moreover, KPS > 70, PTV < 250 cc, systemic therapy during RT treatment and clinical or radiological response were prognostic factors regarding OS (p- value < 0,05). Radiotherapy delivered technique did not influence survival rate or local response, however pts treated with 3DCRT had higher rates of  ≥ G2 acute or late toxicity compared to patients treated with IMRT-VMAT technique with a trend toward  statistically significant (p-value < 0,067). A G3 or higher acute toxicity was observed in only 1,8 % of patients. A  late toxicity ≥ G3 was observed in 8 patients (4,7 %).

Weekly hypofractionated radiotherapy 36,75-42 Gy  in 7-8 fractions appears acceptable in  poor performants status and elderly patients unit of standard RT treatment with a response rate of 75 %. Total dose, KPS > 70, PTV < 259 cc, systemic therapy during RT resulted prognostic factors regarding overall survival. IMRT-VMAT technique is recommended to be used for this schedule of hypofractionated palliative treatment due to reduce G2 or higher toxicity.