Hyperfractionation: where do we stand?

Hyperfractionation is generally expected to allow an escalation of total dose, thereby increasing tumour control rate, without increasing the risk of late complications. The purpose of this review is to assess the empirical evidence for this therapeutic gain from hyperfractionated radiotherapy. Although extensive clinical data have been accumulated until now, especially on treatment of head and neck cancer, the line of evidence is not consistent. The present analysis indicates that the dose per fraction generally used in standard radiotherapy is already a good choice.