Palliative head and neck radiotherapy with the RTOG 8502 regimen for incurable primary or metastatic cancers

Abstract

Objectives To report on our institutional experience of palliative radiotherapy (RT) of cancers in the head and neck by the RTOG 8502 ‘QUAD SHOT’ regimen. Methods Seventy-five patients completed at least 1 cycle of palliative RT to the head and neck for primary or metastatic disease based on the RTOG 8502 regimen (3.7 Gy twice daily over 2 consecutive days at 4 week intervals per cycle) between 2/2005 and 7/2014. Results Median patient age was 76 years (range 23 to 97). The most common histologies were squamous cell carcinoma (55%), non-anaplastic thyroid carcinoma (10%) and salivary gland carcinoma (9%). Thirty patients (40%) received prior RT at the palliative site. Twenty-eight patients (37%) completed at least three RTOG 8502 cycles. Sixty-five percent of all patients had a palliative response. Median overall survival was 5.67 months (range, 0.20 - 34.5). Grade 3 toxicity in 4 patients (5%) consisted of acute dermatitis and functional mucositis. Palliative response was significantly correlated with increasing number of RTOG 8502 cycles (p=0.012), but not KPS, prior RT, palliative chemotherapy, prior surgery, histology or stage. On survival analysis, palliative response (p<0.001), KPS ≥70 (p=0.001), and greater number of RTOG 8502 cycles (p=0.022) remained independent predictors of improved survival. Conclusions For patients with incurable malignant disease in the head and neck, the palliative RTOG 8502 ‘QUAD SHOT’ regimen provides excellent rates of palliative response with minimal associated toxicity. Patients who are able to complete greater number of RT cycles have higher rates of palliative response and overall survival.

Proton Radiotherapy for Recurrent or Metastatic Head and Neck Cancers with Palliative Quad Shot

“…However, many patients are not amenable to curative-intent treatment because of tumor location, extent of disease, poor performance status, and comorbidities. Palliative radiotherapy (RT) is commonly used to control symptoms, improve quality of life (QOL), and possibly, prolong survival in these circumstances [2, 4, 5]. …”

“…In recent years, short-course hypofractionated RT has been considered more suitable than protracted, conventional-fractionation RT because it provides equivalent symptomatic improvement, tumor response, and survival outcomes while shortening overall treatment time and minimizing effects [5–7]. Although a variety of different hypofractionation schemes have been used clinically (from 2.5–8 Gy per fraction, to a total dose of 20–48 Gy), the quad shot regimen is believed to offer the best combination of efficacy, toxicity, and patient convenience [4, 8].…”

“…Early studies demonstrated overall tumor responses of 53% to 77%, with a 53% to 85% improvement in symptom palliation in patients with end-stage head and neck cancers [10–12]. We previously evaluated the combination of quad shot with intensity-modulated RT (IMRT) and demonstrated a comparable palliative response [5], with only 5% of patients experiencing grade 3 to 4 acute toxicities. This regimen is now our current institutional standard for patients requiring palliative RT for incurable cancers of the head and neck [5].…”

“…We previously evaluated the combination of quad shot with intensity-modulated RT (IMRT) and demonstrated a comparable palliative response [5], with only 5% of patients experiencing grade 3 to 4 acute toxicities. This regimen is now our current institutional standard for patients requiring palliative RT for incurable cancers of the head and neck [5]. …”

“…Some tumors recur in a previously heavily irradiated region, limiting additional radiation because of the risk to adjacent healthy structures, such as the spinal cord, brain stem, and temporal lobe. Patients with locally invasive disease near radiosensitive organs at risk (OAR), including the optic nerve and optic chiasm, and patients unable to tolerate additional cycles of palliative RT after the first IMRT quad shot cycle because of treatment toxicities, are poor candidates for photon-based EBRT [5]. …”