title: Cyclical hypofractionated radiotherapy technique for palliative treatment of locally advanced head and neck cancer: institutional experience and review of palliative regimens.
abstract: BACKGROUND
  Effective palliation in patients with locally advanced head and neck cancer is important. Cyclical hypofractionated radiotherapy (Quad Shot) is a short-course palliative regimen with good patient compliance, low rates of acute toxicity, and delayed late fibrosis.
  
  
  OBJECTIVE
  To review use of the Quad Shot technique at our institution in order to quantify the palliative response in locally advanced head and neck cancer.
  
  
  METHODS
  The medical records of 70 patients with head and neck squamous cell carcinoma who had been treated with the Quad Shot technique were analyzed retrospectively (36 had been treated with intensity-modulated radiation therapy and 34 with 3-D conformal radiotherapy). They had received cyclical hypofractionated radiotherapy administrated as 14.8 Gy in 4 fractions over 2 days, twice daily, repeated every 3 weeks for a total of 3 cycles. The total prescribed dose was 44.4 Gy. Primary endpoints were improvement in pain using a verbal numeric pain rating scale (range 1-10, 10 being severe pain) and dysphagia using the Food Intake Level Scale, and the secondary endpoints included overall survival (OS), local regional recurrence-free survival (LRRFS), progression-free survival (PFS) and time to progression.
  
  
  RESULTS
  Pain response occurred in 61% of the patients. The mean pain scores decreased significantly from pre to post treatment (5.81 to 2.55, 𝑃 = .009). The mean initial dysphagia score improved from 2.20 to 4.77 55 (𝑃 = .045). 26% of patients developed mucositis (≤ grade 2), with 9% developing grade 3-level mucositis. 12 patients had tumor recurrence. The estimated 1-year PFS was 20.7%. The median survival was 3.85 months with an estimated 1-year OS of 22.6%. Pain response (hazard ratio [HR], 2.69; 95% confidence index [CI], I.552-1.77) and completion of all 3 cycles (HR, 1.71; 95% CI, 1.003-2.907) were predictive for improved OS.
  
  
  CONCLUSIONS
  This study is a retrospective analysis.
  
  
  CONCLUSIONS
  Quad Shot is an appropriate palliative regimen for locally advanced head and neck cancer.
authors: University of Louisville School of Medicine, Louisville, Kentucky, USA.
authors: Teresa S
authors: TS
authors: Finnegan
authors: University of Louisville Brown Cancer Center, Department of Radiation Oncology, Louisville, Kentucky, USA.
authors: Neal H
authors: NH
authors: Bhatt
authors: University of Louisville Brown Cancer Center, Department of Radiation Oncology, Louisville, Kentucky, USA.
authors: Joseph N
authors: JN
authors: Shaughnessy
authors: University of Louisville Brown Cancer Center, Department of Internal Medicine, Division of Medical Oncology, Louisville, Kentucky, USA.
authors: Cesar
authors: C
authors: Perez
authors: University of Louisville Brown Cancer Center, Department of Internal Medicine, Division of Medical Oncology, Louisville, Kentucky, USA.
authors: Rebecca
authors: R
authors: Redman
authors: University of Louisville Brown Cancer Center, Department of Radiation Oncology, Louisville, Kentucky, USA.
authors: Craig
authors: C
authors: Silverman
authors: University of Louisville Department of Surgery, Division of Otolaryngology, Louisville, Kentucky, USA.
authors: Jeffrey
authors: J
authors: Bumpous
authors: University of Louisville Department of Surgery, Division of Otolaryngology, Louisville, Kentucky, USA.
authors: Kevin
authors: K
authors: Potts
authors: University of Louisville Brown Cancer Center, Department of Radiation Oncology, Louisville, Kentucky, USA. nedunl01@louisville.edu.
authors: Neal E
authors: NE
authors: Dunlap
keywords: QUAD SHOT; chemotherapy; pain control; radiation