Incurable head and neck cancers: will quad shot be an optimum shot?

Abstract

Author(s): Manjula M. V., Pawar Y.S.*, Shamsundar S. D., Shirali Agarwal, Gowtham Raj, Thejaswini B., Nanda R., Aradhana Katke and Ajay GV

Objective: The primary objective was to estimate palliation of symptoms and tumour response. The secondary objective was to evaluate the toxicity and outcome in three palliative hypo fractionated regimens. i.e. conventional, Quad shot schedule, Quad shot with concurrent chemotherapy. Methods: The patients were randomly divided into 3 arms. Arm1 received conventional schedule -30 Gy in 10 fractions, one fraction per day for a period of 2 weeks; Arm 2 patients received quad shot schedule - 14.4 Gy in 4 fractions, 2fractions per day, 6 hours apart, a total of 2 sessions; Arm 3 patients received quad shot schedule-14.4 Gy in 4 fractions, 1 fraction per day with chemotherapy-Carboplatin (AUC2) on day 1 of each cycle, total of 2 sessions. patients were assessed 4 weeks post 1 session, those with progressive disease or grade 3/4 toxicity patients were managed with best supportive care. Patients were evaluated for palliation of symptoms postphase 1, post phase 2, followed by at 1month, 2months up to 6 months’ after completion of phase 2 radiation. Results: The pain relief in arm1, arm 2, arm 3 was 72% (39/55), 82.6% (43/53), and 79.2% (41/52) respectively. Improvements in dysphagia in arm1, arm2, arm3 were 64.2% (35/55), 75% (40/53), and 75% (39/52) respectively. The Grade 2 mucositis were 36% (18/55), 20.7% (11/53), 23.07% (12/52) and grade 3 mucositis were 29% (11/55), 7.54(4/53), 9.6% (5/52) in arm 1, arm 2, arm 3 respectively. The number of patients with grade 1 dermatitis were 36.67% (20), 20% (11), 23.33% (12) and 13.3% (7), 3.33% (2) and 3.33 (2) in arm1, arm 2, arm 3 respectively. Partial response was observed in 25.45% (14/55), 36.67%, (19/53) and 33.33% (17/52) in arm1, arm 2 and arm 3 and stable disease was 56.67% (31/55), 53.33% (28/53) and 56.67% (30/52) respectively. QoL improved in all three arms. Conclusion: Quad shot regimen with or without chemotherapy is comparable with conventional palliative schedule and is associated with adequate symptom relief with acceptable toxicity and better compliance.

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