Cyclical hypofractionated radiotherapy technique for palliative treatment of locally advanced head and neck cancer: institutional experience and review of palliative regimens

Finnegan, Teresa S; Bhatt, Neal; Shaughnessy, J.N.; Perez, Cesar A.; Redman, Rebecca; Silverman, Craig L.; Bumpous, Jeffrey M.; Potts, Kevin; Dunlap, Neal E.

doi:10.12788/jcso.0201

Cited by 28 publications

(35 citation statements)

References 18 publications

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“…Similarly, low rates of grade 3 toxicities using the QUAD shot approach have been shown in other retrospective analyses. 11,12 The significance of completing more cycles of the QUAD shot regimen was reported by Lok et al in the largest retrospective study using QUAD shot. 13 The study included 75 patients with pain, dysphagia, and bleeding secondary to head and neck cancer, 40% of whom had prior radiation at the site of palliation.…”

Section: Quad Shotmentioning

confidence: 92%

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Palliative Radiation Therapy for Head and Neck Cancers

Grewal

Jones

Lin

2019

International Journal of Radiation Oncology*Biology*Physics

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Patients with advanced head and neck cancers who are not eligible for curative treatment represent a challenging cohort of patients to manage given the complexity and severity of their presenting symptoms. Palliative radiation therapy, along with other systemic and surgical measures, has the potential to significantly improve the quality of life of such patients. There is little high-level evidence and a lack of consensus to direct the selection of an optimal palliative radiation regimen. An ideal palliative radiation regimen should alleviate symptoms secondary to the cancer with minimal treatment toxicity and side effects while improving a patient's quality of life. This review presents the treatment approaches, outcomes, and toxicities associated with different radiation regimens and proposes a multidisciplinary framework for the selection of an individualized treatment regimen for patients that centers around patient prognosis, goals of care, logistics of treatment, and the availability of other surgical and systemic therapies.

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Section: Quad Shotmentioning

confidence: 92%

“…Patients deemed to be unsuitable for additional radiation therapy may still benefit from the initial cycle of treatment, as demonstrated in prior studies. 7,11 Option of nonradiation palliative therapies…”

Section: Patient Prognosticationmentioning

confidence: 99%

Palliative Radiation Therapy for Head and Neck Cancers

Grewal

Jones

Lin

2019

International Journal of Radiation Oncology*Biology*Physics

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“…Nowadays, modern diagnostic imaging of MR and FDG/PET-CT, which achieve precise target definition and reduced target volume, has been included in RT planning (12,(17)(18)(19). The previous reported symptom response and overall response of the RTOG 8502 regimen with or without systemic therapy approximated 55%-100% and 65%-85%, respectively (4,5,7,8) (Table 4).…”

Section: Discussionmentioning

confidence: 99%

“…The RTOG 8502 regimen for HNC has been reported to achieve tumor response and palliation in approximate 50% to 85% and 55% to 100% of patients, respectively. Furthermore, toxicity has been reported to be mild, with Grade 3 toxicity present in approximately 0%-10% of patients (2,(4)(5)(6)(7)(8). The current National Comprehensive Cancer Network (NCCN) guidelines recommend the RTOG 8502 regimen using three-dimensional conformal RT (3D-CRT) or intensitymodulated radiotherapy (IMRT) as one of the palliative RT regimens for HNC (9).…”

Section: Introductionmentioning

confidence: 99%

Hypofractionated palliative volumetric modulated arc radiotherapy with the Radiation Therapy Oncology Group 8502 “QUAD shot” regimen for incurable head and neck cancer

Toya¹,

Saitô

Yamaguchi

et al. 2020

Preprint

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Background: To review a single institutional experience of the Radiation Therapy Oncology Group (RTOG) 8502 “QUAD shot” regimen using volumetric modulated arc radiotherapy (VMAT) for incurable head and neck cancer (HNC).Methods: Thirty-four consecutive patients with HNC were treated with at least one cycle of the RTOG 8502 regimen. Treatment plans included the use of VMAT with 6 MV photons generated by a linear accelerator. Two daily fractions of 3.7 Gy were delivered with an interval of at least 6 h for 2 consecutive days, totaling 14.8 Gy over 4 fractions. This was repeated every 3–4 weeks for a total of three cycles. No concurrent systemic therapy was performed.Results: The number of completed cycles was 1 in 6 (18%) patients, 2 in 5 (15%), and 3 in 23 (68%). Tumor response was achieved in 29 (85%) patients and symptom relief in 20 (77%) of 26 patients. Overall response (tumor response or symptom relief) was achieved in 32 (94%) patients. All patients who received 2 or more treatment cycles achieved overall response. Median overall survival (OS) was 5.7 months. Multivariate analysis revealed that completion of all three treatment cycles was significantly associated with better OS (P = 0.002). Grade 2 toxicity was observed in four (12%) patients, but no acute Grade ≥3 or late toxicity was observed.Conclusions: The RTOG 8502 “QUAD shot” regimen using VMAT is effective for incurable HNC with highly reduced toxicity. Treatment with multiple cycles is recommended for better treatment response and/or survival.

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“…It was postulated that a HFRT schedule that delivers doses larger than 2 Gy per fraction, but with a lower overall dose, improves dose escalation strategies to increase tumor control and helps maintain dose equivalence for tumor cure while decreasing the dose delivered to normal tissue . There have been many studies showing the benefits of HFRT in lung cancer, prostate cancer, breast cancer, advanced head and neck cancer and locally advanced inoperative esophageal cancer . Regarding preoperative HFRT, colorectal cancer is the most studied cancer, with research indicating that preoperative HFRT (also called short‐course radiotherapy) is as effective as conventional radiotherapy (also called long‐course radiotherapy) in terms of long‐term survival …”

Section: Discussionmentioning

confidence: 99%

Comparison  of  efficacy, safety, and costs between neoadjuvant hypofractionated radiotherapy and conventionally fractionated radiotherapy for esophageal carcinoma

Lyu

Liu²,

et al. 2019

Cancer Medicine

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Background We compared the efficacy, safety, and costs of hypofractionated radiotherapy (HFRT) and conventional fractionated radiotherapy (CFRT) for the neoadjuvant treatment of esophageal cancer. Materials and Methods Overall, 110 patients with esophageal cancer treated with neoadjuvant chemoradiotherapy from October 2002 to July 2017 were retrospectively included and divided into a HFRT group (42 patients received 30 Gray [Gy]/10 fractions for 2 weeks) and a CFRT group [68 patients received 40 Gy/20 fractions for 4 weeks]. Concurrent chemotherapy comprised cisplatin combined with either 5‐FU or taxane. Surgery was performed 3‐8 weeks after radiotherapy. We compared the outcomes, adverse events, and costs between the two groups. Results Pathological downstaging was achieved in 78.6% of the HFRT group and 83.8% of the CFRT group ( P = 0.612). Compared with the CFRT group, the HFRT group had similar pathological complete response (pCR) (33.3% vs 35.3%; P = 0.834), median overall survival (OS) (40.8 months vs 44.9 months; P = 0.772) and progression free survival (32.7 months vs 35.4 months; P = 0.785). The perioperative complication rates were also similar between the groups, but the treatment time and costs were significantly reduced in the HFRT group ( P < 0.05). Finally, multivariate analysis identified cN0 stage, pathological downstaging and pCR as independent predictors of better OS. Conclusion Preoperative HFRT is effective and safe for esophageal cancer. Moreover, it is similar to CFRT in terms of overall survival and toxicity and is cost effective and less time consuming.

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Cyclical hypofractionated radiotherapy technique for palliative treatment of locally advanced head and neck cancer: institutional experience and review of palliative regimens

Abstract: Quad Shot is an appropriate palliative regimen for locally advanced head and neck cancer.

Cited by 28 publications

References 18 publications

Palliative Radiation Therapy for Head and Neck Cancers

Palliative Radiation Therapy for Head and Neck Cancers

Hypofractionated palliative volumetric modulated arc radiotherapy with the Radiation Therapy Oncology Group 8502 “QUAD shot” regimen for incurable head and neck cancer

Comparison  of  efficacy, safety, and costs between neoadjuvant hypofractionated radiotherapy and conventionally fractionated radiotherapy for esophageal carcinoma

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Cyclical hypofractionated radiotherapy technique for palliative treatment of locally advanced head and neck cancer: institutional experience and review of palliative regimens

Abstract: Quad Shot is an appropriate palliative regimen for locally advanced head and neck cancer.

Cited by 28 publications

References 18 publications

Palliative Radiation Therapy for Head and Neck Cancers

Palliative Radiation Therapy for Head and Neck Cancers

Hypofractionated palliative volumetric modulated arc radiotherapy with the Radiation Therapy Oncology Group 8502 “QUAD shot” regimen for incurable head and neck cancer

Comparison of efficacy, safety, and costs between neoadjuvant hypofractionated radiotherapy and conventionally fractionated radiotherapy for esophageal carcinoma

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Comparison  of  efficacy, safety, and costs between neoadjuvant hypofractionated radiotherapy and conventionally fractionated radiotherapy for esophageal carcinoma