Is Quad Shot regimen as effective as two week radiotherapy for palliation of advanced head and neck carcinoma?

Introduction: This prospective, randomized study was undertaken to compare the palliation achieved by a two day 'Quad Shot' radiotherapy regimen to the standard two weeks treatment prescribed for advanced head and neck cancer at our institute. Methods: Fifty patients with incurable Stage IV cancer of head and neck region were selected for this study following pre-fixed criteria. Patients were randomized to receive either Quad Shot (QS) or the standard dose of 30 Gy/2 weeks/10 fractions for palliation (SR). QS patients received 14 Gy/2 days/4 fractions where two fractions were given per day at an interval of at least 6 h. The same dose was repeated after 4 weeks in patients who showed >50% response. All the patients were evaluated for symptom relief using a visual analogue scale. The pre and post treatment quality of life was evaluated using Washington University questionnaire. The results obtained in each arm were compared using Mann Whitney U test and Wilcoxon log ranked test. The overall and progression free survival were calculated using Kaplan Meier test. Results: Relief of pain, swelling, dysphagia and hoarseness was seen in 62%, 86%, 40% and 63% patients in QS arm as compared to 77%, 91%, 50% and 54% in SR. The quality of life improved after treatment in both arms with no significant statistical difference. The median progression free survival was 3 ± 0.4 months for QS and 4 ± 0.414 months for SR. Discussion: QS was found to be as effective as SR in terms of symptom control and improvement in quality of life. The two-day treatment duration helps outstation patients and their caregivers and more patients can be treated in the same machine. Thus QS can be a viable option for palliative radiation particularly in overcrowded centres with long waiting periods.