Accelerated hypofractionation (OCTA SHOT): Palliative radiation schedule in advanced head and neck carcinoma

Jakhar, Shankar Lal; Purohit, Ramesh; Solanki, A.A.; Murali, Priyanka; Kothari, Trupti; Sharma, Neeti; Kumar, Harvindra Singh

doi:10.4103/jcrt.jcrt_767_16

Cited by 4 publications

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“…In India, there was almost a similar ORR along with significant symptom relief. 19 In contrast to our findings, research conducted in the Netherlands used 50 Gy in 16 fractions for SCC and 45% of patients achieved a CR. This could be because all patients had a considerably greater dosage of radiation with equivalent dose in 2 Gy fractions (EQD2) for tumors about 54.69 Gy 20 compared with our patient's maximal dose with a quad-shot regimen for nine patients, where the EQD2 is 50.69 Gy.…”

Section: Discussioncontrasting

confidence: 99%

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Outcome of Hypofractionated Palliative Radiotherapy Regimens for Patients With Advanced Head and Neck Cancer in Tikur Anbessa Hospital, Ethiopia: A Prospective Cohort Study

Zingeta,

Worku,

Awol

et al. 2024

JCO Glob Oncol

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PURPOSE Head and neck cancers (HNCs) are the third most commonly treated cancer with radiation in Ethiopia. Most patients present with advanced stage and are not candidates for curative treatment. The objective of our study is to assess the outcome of hypofractionated palliative radiotherapy (RT) for advanced HNCs in a resource-limited setting. MATERIALS AND METHODS Patients with histology-proven advanced HNC candidates for hypofractionated palliative RT were enrolled. Three regimens were allowed: 44.4 Gy in 12 fractions, 30 Gy in 10 fractions, and 20 Gy in five fractions. Response to treatment was assessed at baseline and at 4 weeks after treatment completion. The Kaplan-Meier curve was used to measure the survival. RESULTS Between January 2022 and January 2023, 52 patients were enrolled and 25 patients were eligible for outcome assessment. Index symptoms include pain, bleeding, dysphagia, respiratory distress, and others in 25, 13, 10, 6, and 17 patients, respectively. Complete relief of the top three symptoms include pain in 52% of patients, hemostasis in 84% of patients, and dysphagia in 30% of patients. Objectively, 64% of patients attained partial response. For 48% of patients, their quality of life (QoL) improved in one parameter of the physical scores. Moreover, 64% of patients showed improvement in three parameters. The global functional score improved in 80% of patients. One patient had grade 3 xerostomia. At the end of the study period, 44% of patients died. The median survival after radiation was 9 months (95% CI, 7.2 to 10.8) CONCLUSION All palliative hypofractionated regimens used were effective in terms of symptom control, tumor response rate, and QoL, and were well tolerated. This makes it appropriate for our setup because the majority of patients require palliation.

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Section: Discussioncontrasting

confidence: 99%

“… 18 In addition, other existing regimens, such as 28 Gy in eight fractions, are effective in symptom management. 19 The main difference between our study and other studies is that we included all histologic subtypes in which symptom improvement is found, whereas most other studies only addressed SCC.…”

Section: Discussionmentioning

confidence: 96%

Outcome of Hypofractionated Palliative Radiotherapy Regimens for Patients With Advanced Head and Neck Cancer in Tikur Anbessa Hospital, Ethiopia: A Prospective Cohort Study

Zingeta,

Worku,

Awol

et al. 2024

JCO Glob Oncol

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“…Jakhar et al [14] Octa shot study, first response evaluation at 15 days after the day of treatment started, 3 months and 6 months respectively (p Value=0.0001). Grade 3 skin toxicity in 1 pt in Octa shot vs 0 in Quad shot.…”

Section: Resultsmentioning

confidence: 98%

Comparative Evaluation of Octa Shot Versus Quad Shot Palliative Radiotherapy for Advanced Head and Neck Cancer Patients

Jakhar,

Dhaka,

Dhaka

et al. 2023

Asian Pac J Cancer Care

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Background: Majority of Head and Neck Squamous Cell Cancer patients in India present in advanced stages. They are not candidates for multimodality treatment due to loco-regionally advanced disease and poor performance status. Hypo-fractionated regimens have been used for palliation of advanced head and neck cancers. Purpose: The purpose of this study to compare the acute and late toxicity and overall response of octa shot and quad shot radiation therapy as palliative regime in locally advanced head and neck cancers.Materials and methods: A hospital based prospective, randomized study was conducted with 50 patients of advanced Squamous cell carcinoma of head and neck, 25 patients taken in each arm. Two fractions(3.5Gy/#) per day six hours apart was given in four consecutive days (Octa shot). Two fractions (3.5Gy/#) per day six hours apart was given in two consecutive days repeated for one more cycle with a interval of two weeks (Quad shot). Acute toxicities monitored at day 15 &30 and late at 3 & 6 months after the treatment started. Results: Octa shot had slightly better loco-regional control but the difference was statistically insignificant. Octa shot had more grade 2 skin and mucosal reaction than Quad shot. Symptomatic relief, subjective regression and improved QOL were better in Octa shot than Quad shot. Conclusion: The study concludes that “octa shot” is an effective palliative radiotherapy regime with greater yet manageable toxicity in comparison to Quad shot regimen. This regime not only strikes a balance between the economic burden, treatment time, machine load but also helps in selecting patients for further dose escalation based on treatment response and symptomatic relief. However more such trials with longer follow up and larger sample size are required for stronger evidences.

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“…Mudgal et al [20] observed good objective response in 82.6% and 84.7% of patients at primary and nodal sites, respectively. Jakhar et al [21] performed a pilot study to evaluate the effect of an accelerated hypofractionated 4 days schedule (octa shot) in providing palliation to such advanced cases of head and neck cancer. After completion of radiotherapy, first response evaluation done at 15th day showed ≥50% objective response in 14 patients.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Interventional Study to Compare Two Weeks versus Four Weeks Gap in ‘Quad Shot’ Regimen in Locally Advanced Head and Neck Cancers

Singh¹,

Jain²

2020

SJAMS

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Original Research Article Background: Palliative radiotherapy is an effective option for incurable head and neck cancers. It is delivered by a variety of fractionation schedules. The 'QUAD SHOT' (RTOG 8502) palliative radiotherapy regimen offers an overall high palliative response in patients with locally advanced head and neck cancers.The aim of the present study was comparing the outcome of two versus four weeks gaps between consecutive cycles of radiotherapy in terms of toxicity, compliance, tolerability and loco-regional control, with reduction of overall treatment time. Methodology: Total 100 subjects were treated on cobalt teletherapy machine. This regimen consists of 3.7 Gy twice-daily fractions given over two consecutive days per cycle with a rest period of 2 and 4 weeks between the 3 prescribed cycles for a total dose of 44.4 Gy. Sample size is 50 cases in each group. This study was conducted at Department of Radiation Oncology, S.M.S Medical College Jaipur, and Rajasthan. Results: Overall palliative response is 57% in the study group while 62% in control group which is statistically non significant in both groups. Incidence of acute dermatitis and acute mucositis were higher in study group, it was statistically significant (p=0.034) and (p=0.015) respectively but manageable with supportive measures like intravenous fluid, medication and adequate nutrition. Other radiation reactions were comparable and statistically non-significant (p>0.05) in both treatment arms. Conclusion: On the basis of results it may be conclude that Two weeks gap in 'QUAD SHOT' (RTOG 8502) radiotherapy regimen can be used in locally advanced Head and Neck cancers to shorten overall treatment time without compromising overall palliation achieved in terms of symptomatic response and locoregional control with manageable toxicities.

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Accelerated hypofractionation (OCTA SHOT): Palliative radiation schedule in advanced head and neck carcinoma

Abstract: The study concludes that this "octa shot" is an effective palliative radiotherapy schedule. With a decreased duration of hospital stay, it is also favorable for outpatients.

Cited by 4 publications

References 0 publications

Outcome of Hypofractionated Palliative Radiotherapy Regimens for Patients With Advanced Head and Neck Cancer in Tikur Anbessa Hospital, Ethiopia: A Prospective Cohort Study

Outcome of Hypofractionated Palliative Radiotherapy Regimens for Patients With Advanced Head and Neck Cancer in Tikur Anbessa Hospital, Ethiopia: A Prospective Cohort Study

Comparative Evaluation of Octa Shot Versus Quad Shot Palliative Radiotherapy for Advanced Head and Neck Cancer Patients

A Prospective Interventional Study to Compare Two Weeks versus Four Weeks Gap in ‘Quad Shot’ Regimen in Locally Advanced Head and Neck Cancers

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