251P - Is QUAD SHOT palliative cyclical hypo-fractionated radiotherapy in advanced head and neck cancer the way to go? An alternative regimen in low resource countries

Background

Head and neck Squamous cell carcinoma (HNSCC) is the most common cancer in developing countries, especially in South Asia. Nearly two-thirds of patients present in advanced stages and possess a dismal prognosis. We herein describe a prospective single institutional Phase- II study on palliative QUAD SHOT (QS) radiotherapy (RT) regimen in advanced HNC patients in a low resource setting.

Methods

Newly diagnosed 36 patients of advanced HNSCC not suitable for curative treatment were enrolled in this study. 17 patients compromising Stage IV A (AJCC 7^th) and 19 patients were Staged IV B (AJCC 7^th). Palliative QS RT regimen delivered 14 Gy in 4 fractions twice daily at least 6 hours apart on 2 consecutive days. The regimen was designed for up to 3 cycles given every 4 weekly if patient tolerates well and or until no disease progression. Wilcoxon signed-rank and Kruskal-Wallis test was used and a ‘p’ value < 0.016 was taken as significant.

Results

Median age of the cohort was 52.5 yrs (Range: 29 – 72 yrs). Oral cavity (63.9%), oropharynx (22.2%) and hypo-laryngopharynx (12.8%) were the major subsite. Median performance status was ECOG – 2 (33 patients). Mean duration of symptoms was 5 months. Most common symptoms were Pain (100%), dysphagia (83.3%) and neck swelling (58.3%). Majority were smokers (63.9%). Out of 36 patients, 14 (38.9%) managed to complete all 3 cycles of QS RT while 23 patients (63.9%) received 2 or more cycles of QS regimen. 13 patients (36.1%) received only 1 cycle of QS RT. At 1 month post first cycle of QS RT, 23 patients had partial response. None had grade 3 or more radiation dermatitis and mucositis. Mean duration of PFS who received 2 or more cycles of QS RT was 5.5 months. Overall palliative response rate was 72% and symptoms improved in 70% of all patients. Median Overall survival (OS) was 5.7 months (Range, 1.1 – 20.4 months) and those who managed to complete all 3 cycles of QS RT had a median OS of 8.3 months (p = 0.001).

Conclusions

QS RT is a good alternative option in advanced HNC patients in low resource countries. Because of shorter duration of treatment it can be employed effectively in areas with high patient burden of advanced HNC with low infrastructure. Further prospective studies are warranted.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

All India Institute of Medical Sciences (AIIMS), New Delhi.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.