Effectiveness of the QUAD Shot Regimen for Advanced Head and Neck Squamous Cell Carcinoma: A Multicenter Prospective Observational Study (Japanese Radiation Oncology Study Group 18-2).

Abstract

The palliative effects of the QUAD shot regimen were prospectively assessed using 3-dimensional conformal radiation therapy (3D-CRT) or intensity modulated radiation therapy (IMRT) for advanced head and neck squamous cell carcinoma. Fifty patients with stage III to IV head and neck squamous cell carcinoma were enrolled. One cycle consisted of 14 to 14.8 Gy in 4 fractions administered over 2 consecutive days and was repeated up to 3 cycles. Toxicity and quality of life (QOL) were assessed using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0, and the University of Washington QOL Questionnaire, version 4, respectively. Two patients refused treatment prior to the initial cycle, whereas the remaining 48 were included in the analysis. 3D-CRT and IMRT were delivered to 16 (33%) and 32 (67%) patients, respectively. Thirty-nine (81%) patients completed all 3 cycles. Treatment response on physical examination was confirmed in 42 (88%) patients. Radiation therapy-associated grade 3 and 4 toxicities were observed in 4 (8%) and 1 (2%) patients, respectively. Of the 12 domain-specific QOL scores, >50% of patients reported the same or better status across all domains at 3 months. The global QOL scores were well preserved, with >70% of patients reporting the same or better scores, rising to >80% at 3 months. The median overall survival was 8.3 months. Multivariate analysis indicated that a T category < T4 (P = .001) and 3 QUAD shot cycles (P = .004) were significantly associated with improved overall survival. The median progression-free survival was 6.7 months. Multivariate analysis indicated that a T category < T4 (P = .026) and 3 QUAD shot cycles (P = .014) were significantly associated with improved progression-free survival. The QUAD shot regimen using 3D-CRT or IMRT achieves a high completion rate over 3 cycles, good palliative effects with lower toxicity, and improved or stable QOL. Three cycles are preferred for improved treatment outcomes.