Comparative Evaluation of Quad Shot versus Twice Weekly Palliative Radiotherapy for Locally Advanced Head and Neck Cancer

Author(s): Neeraj Kumar1 , Rajeev Atri2 , Vivek Kaushal3 , Rakesh Dhankhar4 , Anil Kumar Dhull5 , Parul Gupta6 , Sheeba Bhardwaj7 , Peoli Mukutawat8

BACKGROUND Majority of Head and Neck Squamous Cell Cancer patients in India present in advanced stages. They are not candidates for multimodality treatment due to locoregionally advanced disease, poor performance status or distant metastasis. Hypo-fractionated regimens have been used for palliation of locally advanced head and neck cancers. Here we aim to compare two different schedules of palliative radiotherapy to evaluate and compare their feasibility, efficacy, tolerability, local control and side effects. METHODS This is a prospective, randomized study, conducted among 60 untreated patients of head and neck squamous cell carcinoma where palliative radiotherapy was indicated. These patients were divided in to two groups of 30 patients each by computer generated randomization. In Group 1, 14.8 Gy/ 4 fractions/ 2 days (2 fraction per day 6 hours apart for 2 consecutive days) repeated for 2 more cycles each with an interval of 3 weeks. In Group 2, 32 Gy/ 8 fractions/ 2 days (2 fraction per day 6 hours apart twice weekly (Wednesday and Saturday) for 4 consecutive weeks). RESULTS Group 1 had slightly better locoregional control but the difference was statistically insignificant. Group 1 had more grade 1 skin and mucosal reaction than group 2. Group 2 had more grade 2 skin and mucosal reaction than group 1. Symptomatic relief (subjective regression) was better in group 1 than group 2. CONCLUSIONS Both quad shot and twice weekly palliative radiotherapy for locally advanced head and neck cancer are comparable in term of efficacy, toxicity and feasibility.