213 - The Effectiveness of QUAD Shot Regimen for Advanced Head and Neck Squamous Cell Carcinoma: A Multicenter Prospective Observational Study (JROSG 18-2)
Presenter(s)
R. Toya1, T. Kodaira2, Y. Tamaki3, A. Motegi4, T. Yamazaki5, N. Mizoguchi6, H. Ariga7, N. Tomita8, O. Tanaka9, K. Ishikawa10, Y. Kosugi11, K. Yasuda12, J. I. Saitoh13, Y. Ota14, and T. Akimoto15; 1Department of Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan, 2Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan, 3Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center, Kasama, Japan, 4Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, Japan, 5Department of Radiation Oncology, Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan, 6Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama, Japan, 7Iwate Medical University School of Medicine, Morioka, Japan, 8Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan, 9Department of Radiation Oncology, Asahi University Hospital, Gifu, Japan, 10Department of Radiation Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan, 11Juntendo University, Department of Radiation Oncology, Tokyo, Japan, 12Department of Radiation Oncology, Hokkaido University Hospital, Sapporo, Japan, 13Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, University of Toyama, Toyama, Japan, 14Department of Radiation Oncology, Hyogo Cancer Center, Akashi, Japan, 15Department of Radiation therapy, Jikei University School of Medicine, Tokyo, Japan
Purpose/Objective(s): Advanced radiotherapy (RT) techniques provide excellent target dose conformity with reduced doses to surrounding organs at risk. Administration of the cyclical hypofractionated RT (QUAD shot) regimen has increased using 3D-CRT or IMRT for advanced head and neck squamous cell carcinoma (HNSCC); however, its palliative effect has not been prospectively evaluated. Therefore, we prospectively assessed the palliative effects of the QUAD shot regimen using 3D-CRT or IMRT.
Materials/Methods: The eligibility criteria included patients with stage III–IV HNSCC who were unfit for curative treatment (e.g., very advanced disease or age, poor performance status, and severe comorbidity). Patients who received re-irradiation to the target volume were excluded. One cycle of the QUAD shot regimen consisted of 14–14.8 Gy in four fractions with at least 6-hour intervals over two consecutive days. This was repeated every 3–6 weeks for up to three cycles. RT included either 3D-CRT or IMRT. Toxicities and quality of life (QOL) were assessed by CTCAE ver. 5.0 and the UW-QOL questionnaire, respectively.
Results: Of the 50 patients registered for this study, 2 refused treatment prior to the first cycle, whereas the remaining 48 patients were included in this analysis. 3D-CRT and IMRT were performed in 16 (33%) and 32 (67%) patients, respectively. The number of completed cycles was 1 in 2 (4%), 2 in 7 (15%), and 3 in 39 (81%) patients. Of the 28 patients radiologically evaluable at 1 month following treatment, a complete response, partial response, and stable disease for the target lesion were observed in 6 (21%), 14 (50%), and 8 (29%) patients, respectively. Progressive disease based on the target lesion was not observed. The median overall survival (OS) was 8.3 months. Multivariate analysis revealed that <T4 category (p = 0.001) and 3 QUAD shot cycles (p = 0.004) were significantly associated with better OS. The median progression-free survival (PFS) was 6.7 months. Multivariate analysis revealed that <T4 category (p = 0.026) and 3 QUAD shot cycles (p = 0.014) were significantly associated with better PFS. Any RT-associated grade 3 and 4 toxicities were observed in 4 (8%) and 1 (2%) patients, respectively. Of the 15 items of the QOL score, the rates of equal or improved one month after treatment were 70%–79% in 6 (40%), 60%–69% in 5 (33%), and 50%–59% in 4 (27%) items, respectively. The rates of equal or improved 3 months after treatment were 80%–89% in 5 (33%), 70%–79% in 5 (33%), 60%–69% in 2 (33%), 50%–59% in 2 (13%), and 40%–49% in 1 (7%) items, respectively.
Conclusion: The QUAD shot regimen using 3D-CRT or IMRT provides an appropriate palliative effect with reduced toxicity and improved or stable QOL. Three cycles of the QUAD shot regimen are preferred for better OS and PFS.