Cyclical hypofractionated radiotherapy also known as “QUAD Shot” alone using intensity-modulated radiotherapy for squamous cell carcinoma of the parotid gland in an 85-year-old patient with multiple comorbidities

Abstract

The IMRT-QUAD shot is reasonable and safe to apply for symptom palliation in elderly multiple comorbid patients with head and neck cancer. 2017 Wiley Periodicals, Inc. Head Neck 39: E55-E60, 2017.

Clinical and radiobiological consideration of cyclical hypofractionated radiation therapy also known as QUAD Shot for neglected skin cancer disfiguring the face of a non-compliant patient who was refusing surgery and protracted radiation therapy: case report

“…Although definitive RT for skin cancers has shown excellent local tumor control and cosmetic outcome (particularly in facial lesions), protracted daily RT regimens can be a huge challenge for patients with lack of social-economic support, physical impairment, or non-compliance to daily treatments. Short-course palliative daily RT regimens (20–30 Gy in 5–10 fractions) for cancer in the head and neck region demonstrated only modest rate of symptom palliation (50%–60%) with high acute grade 3 or higher (grade 3+) mucositis (62%) and dermatitis (56%) [11,12]. Among RT regimens, a QUAD Shot requires only 2 consecutive days of hospital visits per each cycle yet has shown excellent local tumor control (53%–77%) and symptom palliation (56%–85%) with minimum side effects (grade 3+, 6%–9%) in cancer patients [11-15].…”

“…For the BED calculation, the α/β ratio of 3 Gy and 10 Gy is used for late-responding tissues (Gy 3 ) and tumor or early-responding tissues (Gy 10 ). To account for tumor proliferation during the entire course of RT, a median value of 5 days for the potential doubling time and 0.3 for ‘α’ representing the loge of the cells killed per Gy was applied in the BED calculation as previously reported [11]. Whereas BED from a QUAD Shot seemed relatively lower than those from other protracted RT regimens, repeated QUAD Shots had shown excellent tumor responses: 100% with QUAD Shot × 3; 44%–50% with less than QUAD shot x 3 [13].…”

“…The main advantages of QUAD Shot regimen include high tolerance to RT with low toxicity, shortened treatment time, and excellent local tumor/symptom control compared to other protracted palliative RT regimens [11-15]. Practically QUAD Shot regimen allows planning target volume revision for each subsequent cycle of QUAD Shot to account for tumor response from previous QUAD Shot(s), which can permit less radiation dose to the OARs resulting in further lowering toxicity.…”

The Role of Postoperative Radiotherapy and Prognostic Model in Primary Squamous Cell Carcinoma of Parotid Gland

“…IMRT-QUAD was recommended for elderly patients comorbid with head and neck cancer (including parotid gland cancer) in recent studies, which was reasonable and safe to apply for symptom palliation with a reduced number of fractions. IMRT-QUAD can produce more rapid regression in tumors with an earlier alleviation of malignancy-related symptoms, and minimize acute and late toxicities in normal organs ( 30 , 31 ), impacting positively on patients’ quality of life (QoL) ( 32 ). Adjustment of PORT fractionation may need for patients in this high-risk group.…”

Radical radiotherapy in epidermoid cancer in the orbitary region: ideal scheme of hypo-fractionation in times of COVID-19: a case report

“…Although short-term radiotherapy treatment regimens (20-30 Gy in 5-10 fractions) for cancer in the head and neck region can be used, they demonstrated only a moderate palliation rate of symptoms (50-60%) with the presence of mucositis (62%) and dermatitis (56%) grade 2-3. 10,11 The advantage of using radiotherapy regimens such as 54 Gy in 18 fractions is the opportunity to reach equivalent biological doses of 70 Gy that increase the possibility of achieving greater tumor control, along with adequate management of toxicities acute and chronic. In this case, it was impossible to achieve adequate restrictions on the left visual pathway, due to the proximity of the eyeball to the tumor activity at practical mm.…”