Document Type : Original Article(s)
Authors
- Poornachandra Tejaswi siddappa 1
- Shamsundar Sunkappa 2
- Jagannath Kunigal Puttaswamy 2
- Nanda Ramanand 2
- Aradhana Katke 2
- Thejaswini Boraiah 2
1 Department of Radiation Oncology, Karnataka cancer therapy and research institute, Navanagar, Hubli-580025.
2 Department of Radiation Oncology, Kidwai memorial institute of oncology, Hombegowda Nagar, Bengaluru, Karnataka, India-560029.
Abstract
Background: Improvement in quality of life and palliation of symptoms forms the primary end point in patients unfit for definitive treatment modalities. Quad-shot like radiotherapy aims to achieve these objectives with addition of chemotherapy in advanced head and neck malignancy.
Methods
In this study, patients >18 years of age, with advanced head and neck malignancy (stage IVA&B) in non-nasopharyngeal sub-site, not fit for radical treatment were included in this mono-centric, prospective, interventional study. Quad-shot like regimen of 14.4Gray in 4fractions delivered with concurrent carboplatin (AUC2) on day-1 of radiation cycle and reviewed after 3-weeks. Based on palliative response, total two repetition are done. Quality of life analysis was done with European Organization for Research and Treatment– Head & Neck-35 questionnaire Treatment induced toxicity evaluated with common terminology criteria for adverse event version 5.0 and radiation therapy oncology group toxicity grading. Treatment outcome was assessed with response evaluation criteria in solid tumors1.1. Microsoft-excel, SPSS version-22 used to analyze data. Kaplan-Meier survival curves were used for overall survival, P-value<0.05 with Pearson chi-square test and ANOVA was considered as statistically significant.
Results
The palliation of symptoms and improvement in quality of life were recorded in 80% and sustained up to 3 months, with median overall survival of 8±0.411 months, maximum benefit appreciable with larynx compared to other sub-sites. However, grade-4 toxicity reported with one patient in post phase-1 and two patients in post phase-2 and managed with best supportive care.
Conclusion
Quad-shot like radiotherapy with concurrent chemotherapy for advanced head and cancer found to be beneficial in patients unfit for radical treatment resulting in desirable palliative outcome.
Keywords
- Radiation Dose Hypofractionation
- Carboplatin
- Palliative Care
- Quality of Life
- Squamous Cell Carcinoma of Head and Neck
Main Subjects
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination, and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.30476/mejc.2025.104769.2205
- Ferlay J, Colombet M, Soerjomataram I, Parkin DM, Piñeros M, Znaor A, Bray F. Cancer statistics for the year 2020: An overview. Int J Cancer. 2021 Apr 5. doi: 10.1002/ijc.33588. Epub ahead of print. PMID: 33818764.
- Wild CP, Weiderpass E, Stewart BW, editors. World Cancer Report: Cancer research for cancer prevention. Lyon (FR): International Agency for Research on Cancer; 2020. PMID: 39432694.
- Sathishkumar K, Chaturvedi M, Das P, Stephen S, Mathur P. Cancer incidence estimates for 2022 & projection for 2025: Result from National Cancer Registry Programme, India. Indian J Med Res. 2022 Oct-Nov;156(4&5):598-607. doi: 10.4103/ijmr.ijmr_1821_22. PMID: 36510887; PMCID: PMC10231735.
- Grewal AS, Jones J, Lin A. Palliative Radiation Therapy for Head and Neck Cancers. Int J Radiat Oncol Biol Phys. 2019 Oct 1;105(2):254-266. doi: 10.1016/j.ijrobp.2019.05.024. Epub 2019 May 22. PMID: 31128145.
- Dakessian Sailian S, Salifu Y, Saad R, Preston N. Dignity of patients with palliative needs in the Middle East: an integrative review. BMC Palliat Care. 2021 Jul 16;20(1):112. doi: 10.1186/s12904-021-00791-6. PMID: 34271909; PMCID: PMC8285813.
- Robert R, Goldberg M. Palliative, palliative or palliative? Crit Care. 2021 Jun 10;25(1):203. doi: 10.1186/s13054-021-03633-2. PMID: 34112229; PMCID: PMC8194193.
- Strang P. Palliative oncology and palliative care. Mol Oncol. 2022 Oct;16(19):3399-3409. doi: 10.1002/1878-0261.13278. Epub 2022 Aug 12. PMID: 35762045; PMCID: PMC9533690.
- Gutt R, Dawson G, Cheuk AV, Fosmire H, Moghanaki D, Kelly M, Jolly S. Palliative Radiotherapy for the Management of Metastatic Cancer: Bone Metastases, Spinal Cord Compression, and Brain Metastases. Fed Pract. 2015 May;32(Suppl 4):12S-16S. PMID: 30766118; PMCID: PMC6375451.
- Saito T, Yamaguchi K, Toya R, Oya N. Single- Versus Multiple-Fraction Radiation Therapy for Painful Bone Metastases: A Systematic Review and Meta-analysis of Nonrandomized Studies. Adv Radiat Oncol. 2019 Jun 28;4(4):706-715. doi: 10.1016/j.adro.2019.06.003. PMID: 31673664; PMCID: PMC6817531.
- Kil WJ. Rapid and Durable Symptom Palliation With Quad Shot Radiation Therapy to Nonosseous Metastatic/Recurrent Cancer in Elderly or Frail Patients in a Rural Community Clinic. Adv Radiat Oncol. 2021 Dec 17;7(2):100871. doi: 10.1016/j.adro.2021.100871. PMID: 35079665; PMCID: PMC8777150.
- Lorenz J., Fain R., Robbins J.R. Utilization of the ‘QUAD SHOT’ for palliating malignancies of the head and neck. Int J Radiat Oncol Biol Phys. 2018;102(3):e445. doi: 10.1016/j.ijrobp.2018.07.1289.
- Hintelmann K, Kriegs M, Rothkamm K, Rieckmann T. Improving the Efficacy of Tumor Radiosensitization Through Combined Molecular Targeting. Front Oncol. 2020 Aug 4;10:1260. doi: 10.3389/fonc.2020.01260. PMID: 32903756; PMCID: PMC7438822.
- Rich SE, Chow R, Raman S, Liang Zeng K, Lutz S, Lam H, Silva MF, Chow E. Update of the systematic review of palliative radiation therapy fractionation for bone metastases. Radiother Oncol. 2018 Mar;126(3):547-557. doi: 10.1016/j.radonc.2018.01.003. Epub 2018 Feb 1. Erratum in: Radiother Oncol. 2019 Jun;135:201. doi: 10.1016/j.radonc.2019.03.023. PMID: 29397209.
- Lok BH, Jiang G, Gutiontov S, Lanning RM, Sridhara S, Sherman EJ, Tsai CJ, McBride SM, Riaz N, Lee NY. Palliative head and neck radiotherapy with the RTOG 8502 regimen for incurable primary or metastatic cancers. Oral Oncol. 2015 Oct;51(10):957-62. doi: 10.1016/j.oraloncology.2015.07.011. Epub 2015 Aug 14. PMID: 26282714; PMCID: PMC4758812.
- Singh, Charan & Jain, Sandeep. (2020). A Prospective Interventional Study to Compare Two Weeks versus Four Weeks Gap in ‘Quad Shot’ Regimen in Locally Advanced Head and Neck Cancers. Scholars Journal of Applied Medical Sciences. 8. 1403-1407. doi: 10.36347/sjams.2020.v08i06.003.
- Velu U, Sharan K, Singh A, Salins S, Reddy A. The Effectiveness of PAlliative Split COurse RAdiotherapy (PASCORA) Regimen in Non-Metastatic Head and Neck Cancer Patients Who are Treated with Palliative Intent–A Retrospective Single Center Study. International Journal of Radiation Oncology, Biology, Physics. 2022 Nov 1;114(3):e312. doi: 10.1016/j.ijrobp.2022.07.1369.
- Gamez ME, Agarwal M, Hu KS, Lukens JN, Harrison LB. Hypofractionated Palliative Radiotherapy with Concurrent Radiosensitizing Chemotherapy for Advanced Head and Neck Cancer Using the "QUAD-SHOT Regimen". Anticancer Res. 2017 Feb;37(2):685-691. doi: 10.21873/anticanres.11364. PMID: 28179317.
- Upadhyay R, Gogineni E, Tocaj G, Ma SJ, Bonomi M, Bhateja P, Konieczkowski DJ, Baliga S, Mitchell DL, Jhawar SR, Zhu S, Grecula JC, Dibs K, Gamez ME, Blakaj DM. Palliative Quad Shot Radiation Therapy with or without Concurrent Immune Checkpoint Inhibition for Head and Neck Cancer. Cancers (Basel). 2024 Mar 5;16(5):1049. doi: 10.3390/cancers16051049. PMID: 38473406; PMCID: PMC10931206.
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