PALLIATIVE QUAD SHOT RADIOTHERAPY IN ADVANCED HEAD AND NECK CANCER (HNC) – IMPACT ON SYMPTOMATIC RELIEF AND QUALITY OF LIFE

Presentation: AHNS-QS-098
Topic: Radiation Therapy
Type: Quickshot
Date: Thursday, May 2, 2019
Session: 5:30 PM - 6:00 PM
Authors: Subhash Chander, MD, Ravi Kanodia, Suman Bhasker, MD, Ritesh Kumar, A Biswas, H Verma
Institution(s): All India Institute of Medical Sciences, New Delhi

Introduction: Head and Neck Cancer (HNC) is one of the most common cancers in developing countries.  Approximately one-third of patients presents in advanced stages and are unfit for curative treatment. The therapeutic goals in these patients are palliation of symptoms and improving quality of life (QOL). We prospectively investigated the role of palliative RT in 2 days (QUAD SHOT) on QOL in these advanced HNC patients unfit for curative treatment.

Objectives: The study aims to evaluate symptom relief and quality of life (QOL) in advanced HNC patients treated with QUAD-SHOT Radiotherapy.

Methods: 36 patients of advanced HNC were recruited in this prospective study.  Palliative QUAD SHOT RT delivers 14 Gy in 4 fractions twice daily 6 hours apart on 2 consecutive days. The regimen was delivered every 4 weeks for a maximum of 3 cycles if the disease shows response. Symptom relief was assessed using EORTC H&N 35 questionnaire and QOL was assessed with EORTC QLQ-C30 questionnaire. Permission was taken to use these standard questionnaires. Statistical analysis was done using SPSS v.20.

Results: Median age of the group was 52.5 yrs with ECOG Performance Scale (PS) 2. Stage IV-A and IV-B comprised 16 and 20 patients respectively. 31 patients were males and 5 patients were females. Most common sites were oral cavity (63.9%), oropharynx (22.2%) and larynx (13.8%). Mean duration of symptoms was 5 months with Pain (100%), dysphagia (83.3%) and neck swelling (75%) being major symptoms. 23 patients (63.9%) received ≥2 cycles of QUAD SHOT RT of which 14 patients (38.9%) completed three cycles.

The mean baseline pain score was 32.40 (SD, 14.19) while the mean pain score after one month of first , second and third cycles of radiation treatment was 12.82  (SD, 10.60), 9.80 (SD, 9.87) and 4.76 (SD, 7.81) respectively. Similarly, the mean initial dysphagia score was 32.87 (SD, 17.69) whereas it changed to 7.14 (SD, 3.02) after the third cycle of QUAD-shot RT.

The mean global health score (GHS) in this study at the baseline was 45.13 (SD, 13.99), while at 3 and 6 months, the mean score was 63.72 (SD, 11) and 60.41 (SD, 8.65) respectively.

Conclusions: Palliative QUAD SHOT RT is a feasible treatment option in advanced HNC patients unfit for curative treatment. It produces quick symptomatic relief in short duration and improves QOL. Thus QUAD SHOT RT can be used effectively in institutes with high patient burden of advanced HNC in limited resource countries.

Keywords: Radiotherapy; Quad shot; Palliation; Advanced head and neck cancer; QOL