Research Article | DOI: https://doi.org/10.31579/2690-4861/1118
Senior resident, Radiation oncology department, Sarojini Naidu Medical College, Agra, Uttar Pradesh, Pin code: 282003, India.
*Corresponding Author: Shivani Malik
Citation: Shivani Malik, Ashok Kumar Arya. (2026), Comparative Evaluation of Christie Versus Conventional Palliative Radiotherapy in Patients with Incurable Locally Advanced Head and Neck Squamous Cell Carcinoma: A Prospective Randomized Study, International Journal of Clinical Case Reports and Reviews, 36(2); DOI:10.31579/2690-4861/1118
Copyright: © 2026, Shivani Malik. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 21 May 2026 | Accepted: 27 May 2026 | Published: 04 June 2026
Keywords: locally advanced head and neck cancer; squamous cell carcinoma; palliative radiotherapy; christie regimen; hypofractionation; conventional
Background: Patients presenting with incurable locally advanced head and neck squamous cell carcinoma (LAHNSCC) frequently experience significant symptoms requiring effective palliation. Several hypofractionated radiotherapy regimens are used in clinical practice; however, no universally accepted standard schedule exists. This study was conducted to compare the clinical outcomes of two commonly used palliative radiotherapy schedules—Christie and conventional hypofractionated radiotherapy—in this patient population.
Objectives: To compare treatment response, toxicity profile, treatment tolerance, quality of life, and survival outcomes between Christie and conventional palliative radiotherapy regimens in patients with incurable locally advanced head and neck squamous cell carcinoma.
Methods: This prospective randomized study included 70 patients with treatment-naïve, incurable LAHNSCC who were unsuitable for definitive therapy. Patients were randomized in a 1:1 ratio into two treatment groups.
Patients were evaluated before treatment, at completion of radiotherapy, and at one-month follow-up. Tumor response was assessed using WHO response criteria, while treatment-related toxicities were graded according to RTOG guidelines. Quality of life was evaluated using the University of Washington Quality of Life Questionnaire (UW-QOL, version 4).
Results: Treatment completion rates were 80% in the Christie arm and 72% in the conventional arm. Partial tumor response was observed in 92.8% of patients receiving Christie radiotherapy and 96% of those treated with the conventional regimen. Complete nodal response occurred more frequently in the Christie group (85.7%) compared with the conventional group (76%). Grade 3 mucositis was observed in four patients in the Christie arm, whereas no grade 3 mucositis occurred in the conventional arm. Significant improvement in performance status and quality-of-life scores was observed in both treatment groups. Median overall survival was 6 months in the Christie arm compared with 3.5 months in the conventional arm.
Conclusion: Both palliative radiotherapy regimens provided meaningful symptom relief and improvement in quality of life in patients with incurable LAHNSCC. However, the Christie schedule demonstrated improved locoregional control and longer overall survival with manageable toxicity. These findings suggest that the Christie regimen may represent a preferable palliative radiotherapy option for appropriately selected patients.
Head and neck cancers represent a significant global health burden and are among the most frequently diagnosed malignancies worldwide. According to recent global cancer estimates, cancers of the lip and oral cavity accounted for more than one million newly diagnosed cases in 2022. These malignancies constitute a major proportion of cancers in many developing nations, particularly in South Asia. In India, head and neck cancers rank among the most common cancers, with lip and oral cavity malignancies representing the second most frequently diagnosed cancer type. A considerable proportion of patients in India present with advanced disease at the time of diagnosis, often due to delayed healthcare access, socioeconomic limitations, and high prevalence of tobacco-related risk factors.
Management of locally advanced head and neck squamous cell carcinoma (LAHNSCC) generally requires a multidisciplinary approach involving surgery, radiotherapy, and systemic therapy. However, a substantial number of patients present with disease that is either unresectable or unsuitable for radical treatment. Advanced stage disease, extensive locoregional involvement, poor nutritional status, and compromised performance status frequently makes aggressive multimodality treatment impractical. In such circumstances, the primary goal of therapy shifts from cure to palliation, with emphasis on alleviating distressing symptoms and maintaining an acceptable quality of life.
Patients with incurable LAHNSCC often experience a range of debilitating symptoms including severe pain, dysphagia, ulceration, bleeding, foul odor, and functional impairment affecting speech and swallowing. These symptoms significantly compromise nutritional intake, physical activity, and psychosocial well-being. Therefore, effective palliative strategies are essential to reduce symptom burden and enhance patient comfort during the remaining course of the disease.
Radiotherapy plays a pivotal role in the palliative management of advanced head and neck cancer because it can provide rapid symptom relief, improve local disease control, and preserve organ function. In contrast to radical treatment schedules that require prolonged treatment duration, hypofractionated radiotherapy regimens are often preferred in the palliative setting. These schedules deliver larger doses per fraction over a shorter period, making them more convenient for patients with limited life expectancy and reduced tolerance to lengthy treatment courses.
Despite the widespread use of palliative radiotherapy in this clinical setting, there is no universally accepted standard dose-fractionation schedule. Various hypofractionated regimens have been proposed and evaluated, each attempting to achieve a balance between treatment efficacy, patient convenience, toxicity profile, and healthcare resource utilization. Among the commonly employed regimens, the Christie schedule and conventional hypofractionated radiotherapy are frequently used in clinical practice for symptom control in patients with incurable disease.
The Christie regimen delivers a moderately hypofractionated radiation dose over a relatively short treatment duration and has been reported to produce encouraging symptomatic improvement and tumor response. Conventional hypofractionated schedules, on the other hand, provide a simpler treatment approach and are often considered in patients with poor performance status or logistical limitations. However, data directly comparing the clinical outcomes of these regimens remain limited.
Considering the high burden of advanced head and neck cancer in resource-constrained settings and the need for effective yet practical palliative treatment strategies, further evaluation of different hypofractionated schedules is warranted. The present prospective randomized study was therefore undertaken to compare the toxicity, treatment tolerance, tumor response, quality of life, and survival outcomes associated with Christie and conventional palliative radiotherapy regimens in patients with incurable locally advanced head and neck squamous cell carcinoma.
Aim
To compare the efficacy and tolerability of the Christie regimen and conventional palliative radiotherapy schedule in patients with incurable locally advanced head and neck squamous cell carcinoma.
Objectives
To evaluate and compare tumor response, treatment-related toxicities, changes in performance status, quality of life, and overall survival between patients treated with the Christie regimen and those receiving conventional palliative radiotherapy.
Study Design and Patient Selection
This prospective randomized comparative study was conducted in the Department of Radiation Oncology at Sarojini Naidu Medical College, Agra, between March 2023 and March 2025. The study included patients diagnosed with locally advanced head and neck squamous cell carcinoma (LAHNSCC) who were considered unsuitable for definitive curative treatment.
A total of 70 treatment-naïve patients meeting the eligibility criteria were enrolled after obtaining written informed consent. Ethical approval for the study was obtained from the Institutional Ethics Committee of SN Medical College, Agra.
Patients were randomly assigned in a 1:1 ratio into two treatment groups, with 35 patients in each arm.
Eligibility Criteria
Patients were included if they had:
Patients were excluded if they had distant metastasis, prior treatment for head and neck cancer, non-squamous histology, primary tumors of the thyroid, paranasal sinuses, salivary glands, nasal cavity, or nasopharynx, significant uncontrolled comorbidities, or pregnancy/lactation.
Treatment Protocol
Patients were allocated using simple randomization (draw of lots) into the following treatment arms:
Arm A (Christie regimen):
Patients received 50 Gy in 16 fractions over 3.1 weeks (3.125 Gy per fraction, five fractions per week). Spinal cord sparing was performed after the 11th fraction through replanning.
Arm B (Conventional hypofractionated regimen):
Patients received 20 Gy in 5 fractions (4 Gy per fraction) over one week, followed by a repeat course after a three-week interval, resulting in a total dose of 40 Gy in 10 fractions over 3.5 weeks. Spinal cord sparing was implemented during replanning for the final fraction.
Radiotherapy Technique
All patients underwent treatment simulation prior to radiotherapy. Treatment was delivered in the supine position using parallel opposed lateral fields encompassing the primary tumor and involved cervical lymph nodes. Radiation was delivered using a Cobalt-60 teletherapy unit, with dose prescribed to the midplane at the central axis.
Pretreatment Evaluation
Baseline assessment included detailed clinical examination, Karnofsky performance status evaluation, complete blood counts, renal and liver function tests, and radiological investigations including chest X-ray, ultrasonography of the abdomen, and contrast-enhanced CT scan of the head and neck. Tumor staging was performed according to the AJCC 8th edition staging system.
Treatment Assessment and Follow-Up
Patients were evaluated daily during radiotherapy and weekly during treatment intervals. Acute radiation toxicities were graded according to the Radiation Therapy Oncology Group (RTOG) criteria. Tumor and nodal responses were assessed using WHO response criteria.
Quality of life was assessed using the University of Washington Quality of Life Questionnaire (UW-QOL, version 4) at baseline, at completion of treatment, and at one-month follow-up.
Patients were followed for at least six months or until death, with clinical assessment at each visit to evaluate treatment response, symptom relief, and disease progression.
Statistical Analysis
Data analysis was performed using SPSS version 28.0.1. Categorical variables were compared using the Chi-square test, while changes in quality-of-life scores were analyzed using the Wilcoxon signed-rank test. Survival outcomes were estimated using the Kaplan–Meier method, and a p-value < 0>
A total of 70 patients were enrolled in the study and randomized equally into two treatment arms (35 patients each). During treatment, 6 patients (17.1%) in the Christie arm and 10 patients (28.5%) in the conventional arm discontinued treatment prematurely. These patients were retained in the analysis according to the intention-to-treat principle.
The median age of patients was 50 years (range: 27–70) in the Christie arm and 53 years (range: 22–73) in the conventional arm. A male predominance was observed in both groups (91.2% in the Christie arm and 71.4% in the conventional arm).
Chewable tobacco use was the most common addiction, reported in 85.7% of patients in the Christie arm and 80% in the conventional arm. The oral cavity was the most frequently involved primary site in both treatment groups. Most tumors were classified as moderately differentiated squamous cell carcinoma, and all patients belonged to stage IV disease, with a higher proportion of stage IVA cases in the Christie arm and stage IVB in the conventional arm.
Pain was the most common presenting complaint, followed by dysphagia, cosmetic disfigurement, difficulty in chewing, and reduced physical and social activity. Nasogastric tube feeding was required in approximately 47% of patients during the course of treatment.
Table 1: Baseline Demographic and Clinical Characteristics.
| Parameter | Arm A (Christie) | Arm B (Conventional) |
|---|---|---|
| Age (years) | Median 50 (Range 27–70) | Median 53 (Range 22–73) |
| Gender | Male: 31 (91.2%) Female: 4 (11.4%) | Male: 25 (71.4%) Female: 10 (28.6%) |
| Tobacco chewing | 30 (85.7%) | 28 (80%) |
| Smoking | 27 (77.1%) | 24 (68.6%) |
| Primary Site | Oral cavity: 21Oropharynx: 11Larynx: 3 | Oral cavity: 27Oropharynx: 4Larynx: 4 |
| Histology (MDSCC) | 23 (65.7%) | 22 (62.8%) |
| Stage IVA / IVB | 23 (65.7%) / 12 (34.3%) | 17 (48.6%) / 18 (51.4%) |
Performance status was evaluated using the Karnofsky Performance Scale (KPS) before and after radiotherapy. Both treatment arms demonstrated statistically significant improvement in KPS scores following treatment (p < 0>.
The mean KPS score increased from 53.45 ± 8.14 to 69.63 ± 6.49 in the Christie arm, while in the conventional arm it improved from 50.8 ± 11.52 to 64.0 ± 9.57. The magnitude of improvement was greater in patients treated with the Christie regimen.
Table 2: Karnofsky Performance Status (KPS) Before and After Radiotherapy.
| Parameter | Arm A (Christie) | Arm B (Conventional) |
|---|---|---|
| Pre-RT Mean KPS | 53.45 ± 8.14 | 50.8 ± 11.52 |
| Post-RT Mean KPS | 69.63 ± 6.49 | 64.0 ± 9.57 |
| Improvement | Significant | Significant |
| p-value | <0> | <0> |
The most frequently observed radiation-related toxicities were mucositis and dermatitis. Mucositis typically appeared after approximately eight fractions of radiotherapy.
Grade 3 mucositis was documented in four patients in the Christie arm, whereas no cases of grade 3 mucositis were observed in the conventional arm. No grade 3 dermatitis was reported in either treatment group. Approximately 20 patients required hospitalization for management of mucositis during treatment.
At the one-month follow-up, no significant severe radiation-related toxicity was observed in either arm.
Figure 1: Toxicity comparison.
Tumor response was evaluated at completion of treatment using WHO response criteria.No patient in either arm achieved complete response at the primary tumor site. Partial tumor response was observed in 92.8% of patients in the Christie arm and 96% of patients in the conventional arm, while the remaining patients demonstrated stable disease. No cases of progressive disease were recorded during the initial response
assessment.
With respect to nodal disease, complete nodal response was observed in 85.7% of patients receiving the Christie regimen and 76% of those treated with the conventional schedule. Partial nodal response was seen in the remaining patients.
Table 3: Objective Tumor and Nodal Response.
| Response | Arm A (Christie) | Arm B (Conventional) |
|---|---|---|
| Tumor Response | ||
| Partial response | 26 (92.8%) | 24 (96%) |
| Stable disease | 2 (7.2%) | 1 (4%) |
| Progressive disease | 0 | 0 |
| Nodal Response | ||
| Complete response | 24 (85.7%) | 19 (76%) |
| Partial response | 4 (14.3%) | 6 (24%) |
At the first follow-up visit, 27 patients in the Christie arm and 25 patients in the conventional arm were available for evaluation. Two patients in the conventional arm and one patient in the Christie arm expired within the first month following radiotherapy.
After radiotherapy, 42 patients were able to tolerate palliative chemotherapy due to improvement in their general condition. The most commonly administered regimen consisted of weekly intramuscular methotrexate (50 mg) combined with oral gefitinib (250 mg daily). A small number of patients received paclitaxel–carboplatin combination chemotherapy, depending on their performance status and institutional treatment protocol.
Quality of life was assessed using the UW-QOL questionnaire. Significant improvement in overall quality of life scores was observed in both treatment groups (p < 0>). The overall QOL score improved from 21.89 ± 12.45 to 71.48 ± 19.88 in the Christie arm, and from 22.65 ± 12.98 to 68.64 ± 18.64 in the conventional arm.Marked improvement was observed in domains including pain, appearance, swallowing, chewing, speech, physical activity, mood, and anxiety. However, taste and saliva scores declined after treatment in both groups, reflecting radiation-induced xerostomia and taste alteration. Symptomatic improvement, particularly in pain relief, was more pronounced in patients treated with the Christie regimen.
Table 4: Quality of Life (UW-QOL) Change After Radiotherapy.
| Domain | Arm A (Christie) | Arm B (Conventional) |
|---|---|---|
| Pain | 21.43 → 89.29 | 34.38 → 89.67 |
| Appearance | 38.39 → 78.57 | 37.50 → 77.08 |
| Activity | 38.39 → 71.43 | 42.71 → 66.67 |
| Swallowing | 23.57 → 56.07 | 38.71 → 72.46 |
| Chewing | 17.86 → 51.14 | 19.79 → 37.50 |
| Mood | 33.93 → 83.04 | 33.33 → 67.71 |
| Overall QOL | 21.89 → 71.48 | 22.65 → 68.64 |
| p-value | <0> | <0> |
Patients were followed for a minimum duration of six months (range: 6–21 months) or until death. The median overall survival was 6 months in the Christie arm compared with 3.5 months in the conventional arm. Kaplan–Meier survival analysis demonstrated better survival outcomes in patients receiving the Christie schedule.
Table 5: Median Overall Survival.
| Treatment Arm | Median Survival (months) | 95% CI |
|---|---|---|
| Christie (Arm A) | 6.0 | 4.48 – 7.52 |
| Conventional (Arm B) | 3.5 | 1.35 – 4.65 |
Figure 2: Statistically simulated survival curve.
Advanced head and neck squamous cell carcinoma remain a major health concern in developing countries, where a large proportion of patients present with locally advanced and unresectable disease. In such situations, treatment is primarily palliative, with the goal of relieving distressing symptoms and improving quality of life rather than achieving cure. Hypofractionated radiotherapy schedules are therefore widely used because they provide rapid symptom control with shorter treatment duration, which is particularly beneficial for patients with limited life expectancy.
In the present study, two commonly used palliative radiotherapy regimens—the Christie schedule and a conventional hypofractionated regimen—were evaluated in patients with incurable locally advanced head and neck squamous cell carcinoma. Both regimens demonstrated significant improvement in performance status following radiotherapy, indicating effective symptom palliation. Improvement in Karnofsky Performance Status was greater in the Christie arm, suggesting better functional recovery. Similar improvements in performance status following palliative radiotherapy have been reported in previous studies evaluating hypofractionated schedules for advanced head and neck cancers.
Treatment-related toxicity in this study was generally manageable. Mucositis was the most frequently observed adverse effect, with a small proportion of patients in the Christie arm developing grade 3 mucositis. These findings are comparable to those reported by Soni A and colleagues, who observed higher rates of grade 3 mucositis in patients treated with the Christie regimen compared with other hypofractionated schedules. Likewise, A. Al-Mamgani et al., who originally described the Christie regimen, also reported significant mucosal toxicity, although it was considered acceptable in view of the clinical benefits achieved. In contrast, studies by B. K. Mohanti et al. and S. Das using the 40 Gy/10 fraction schedule reported relatively lower rates of severe toxicity.
The tumor response observed in the present study was encouraging. A high proportion of patients in both arms achieved partial tumor regression, while nodal response was slightly better in the Christie arm. These findings are broadly consistent with earlier reports. For example, John Corry et al. demonstrated good objective response rates with hypofractionated palliative radiotherapy in advanced head and neck cancers. Similarly, studies by S. Ghoshal et al. and Ankur Mudgal et al. have reported favorable locoregional response following short-course palliative radiotherapy schedules.
Quality of life is a critical endpoint in patients receiving palliative treatment. In the present study, both treatment arms showed significant improvement in overall quality-of-life scores, particularly in domains related to pain relief, swallowing, activity, and emotional well-being. However, taste and salivary function declined following treatment, which is consistent with radiation-induced xerostomia reported in previous studies. Similar improvements in multiple quality-of-life domains have been described by Soni A et al. and S. Ghoshal et al., highlighting the role of palliative radiotherapy in reducing symptom burden in advanced head and neck cancer.
With regard to survival outcomes, the median overall survival was higher in the Christie arm compared with the conventional regimen in the present study. Although survival in such patients is generally limited, previous studies have reported variable survival outcomes with hypofractionated radiotherapy schedules. For instance, S. Das et al. reported a median survival of approximately 7 months, while Ankur Mudgal et al. reported survival approaching 9 months in selected patients receiving palliative radiotherapy.
Overall, the findings of this study suggest that both regimens are effective in providing symptomatic relief in patients with incurable disease. However, the Christie schedule demonstrated comparatively better locoregional response, improvement in performance status, and longer survival, although with slightly higher acute mucosal toxicity.
Nevertheless, the study has certain limitations, including a relatively small sample size and limited follow-up duration, which may affect the interpretation of long-term outcomes. Future multicenter studies with larger patient populations and longer follow-up would help establish the optimal palliative radiotherapy schedule for patients with advanced head and neck cancer.
Palliative radiotherapy plays a crucial role in the management of patients with incurable locally advanced head and neck squamous cell carcinoma, where the primary goal of treatment is symptom relief and improvement in quality of life. In the present study, both the Christie regimen and the conventional hypofractionated schedule demonstrated meaningful clinical benefit in terms of symptom palliation, improvement in performance status, and enhancement of overall quality of life.
Although both treatment approaches were effective, patients treated with the Christie regimen showed comparatively better locoregional response, greater improvement in performance status, and longer median overall survival. While a slightly higher incidence of acute mucosal toxicity was observed with this regimen, these adverse effects were manageable with appropriate supportive care.
Based on the findings of this study, the Christie schedule appears to offer a favorable balance between treatment efficacy and tolerability, making it a suitable palliative radiotherapy option for patients with incurable locally advanced head and neck cancer, particularly in resource-limited healthcare settings.
Further large-scale multicenter studies with longer follow-up are required to confirm these findings and to establish an optimal palliative radiotherapy schedule for this patient population.
Acknowledgements
Thankful to my husband, all the patients and departmental staff. The authors affirm that they have no conflicts of interest, either financial or otherwise. No direct or indirect funding was received for this clinical work
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Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
