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Palliative head and neck (H&N) radiation shouldn’t be an oxymoron. Here is an excellent data summary and proposed thought process behind any H&N radiation approach that has an ultimate goal of alleviating symptoms. As you might imagine, after a muli-D decision that disease is not curative, the first fork in the road comes with an assessment of overall life expectancy. If <4 months or <12 months with foreseeable options for salvage palliation, the go-to should be the quad shot. We know, we know, this is already your go-to. But here we’re talking 3.7 Gy twice daily x 2 days. Conversely, a longer life expectancy coupled with patient prioritization of durability over comfort and convenience, try something like 6 Gy x 5 or 2.5 Gy x 20 on for size. Finally, for a patient with extended life expectancy and a desire for the most aggressive local treatment regardless of short-term quality of life, it’s not unreasonable to offer conventionally-fractionated radiation +/ concurrent chemo or radiosurgery in the setting of re-irradiation. TBL: We now have an UpToDate-worthy no-nonsense treatment algorithm for palliative H&N radiation. | Grewal, Int J Radiat Oncol Biol Phys 2019