A randomized trial of 190 frail elderly patients with head and neck cancer found that hypofractionated split-course radiotherapy achieved equivalent 6-month tumor control compared to standard fractionation, with complete locoregional response rates of 58.9% versus 61.5% respectively. The split-course approach delivers radiation in two phases separated by a treatment break, potentially reducing acute toxicity while maintaining efficacy. This finding addresses a critical gap in cancer care for older adults, who comprise 60% of head and neck cancer cases yet are often excluded from clinical trials due to frailty concerns. The equivalence in tumor control suggests that treatment breaks don't compromise immediate cancer response, challenging traditional radiotherapy paradigms that emphasize uninterrupted delivery. However, the study revealed concerning survival differences that weren't fully explained by baseline characteristics, suggesting split-course therapy should remain reserved for patients truly unable to tolerate standard treatment. For geriatricians and oncologists managing frail patients, this provides evidence-based justification for a gentler approach when standard radiotherapy poses prohibitive risks, though careful patient selection remains paramount.