Palliative Care

PV QA 3 - Poster Viewing Q&A 3

TU_31_3044 - Utilization of the 'QUAD SHOT' for Palliating Malignancies of the Head and Neck

Tuesday, October 23
1:00 PM - 2:30 PM
Location: Innovation Hub, Exhibit Hall 3

Utilization of the ‘QUAD SHOT’ for Palliating Malignancies of the Head and Neck
J. Lorenz, R. Fain III, and J. R. Robbins; Medical College of Wisconsin, Milwaukee, WI

Purpose/Objective(s): The QUAD SHOT is a palliative radiotherapy (RT) regimen for malignancies of the head and neck that offers excellent symptomatic relief with minimal toxicity relative to other fractionation schedules. It used BID radiation doses delivered on consecutive days with a 3-4 week break before repeating. It provides significant palliation and social convenience for patients while allowing for additional treatments for good responders. We hypothesize this regimen is underused and we seek to illustrate practice trends, the clinical characteristics of the patients receiving this regimen, and evaluate utilization.

Materials/Methods: The National Cancer Database (NCDB) was queried for patients with malignancies of the H&N who received palliative RT. We reviewed dose fractionation schedules and selected those who received 3.3 to 3.9 Gy per fraction for 12-16 fractions (QUAD SHOT). Univariate Cox-regression analyses were conducted to determine the impact of several variables (treatment in an academic vs. community setting, age over 65, Stage IV disease, Charlson Deyo score ≥2) on overall survival.

Results: A total of 8,697 patients with predominantly squamous cell carcinomas diagnosed between 2004 and 2014 were identified as receiving some form of palliative treatment. Of these, 2,436 patients (28%) received palliative RT and 162 (7%) were determined to have received the QUAD SHOT with most receiving 3.5 or 3.7 Gy fractions. The median age of the cohort was 71 (IQR 61-82). Overall, the majority of patients were male (70%), Caucasian (71%) and had no other comorbidities (70%). Seventy-eight percent of patients were covered by governmental insurance and 63% were treated at an academic institution. Locally advanced lesions comprised 51% of cases while M1 disease was seen in 29% of patients. The cohort’s median survival after initiation of palliative RT was 3.5 months with 30% living 6 months and just 14% living one year. Just over half of patients (54%) completed one cycle while 28% completed all three cycles. Data analysis did not identify the previously mentioned variables as statistically significant predictors of survival, but as expected the number of completed cycles was associated with improved survival. The median survival base on the number of completed cycles was 6 months for 3 cycles, 3.4 months for 2 cycles, 2.3 months for 1 cycle and 2 weeks for less than a cycle (p<0.001). An upward trend in the rate of QUAD SHOT utilization was identified with 53% of the cases occurring in the final three years (2012-2014) of the study.

Conclusion: The QUAD SHOT is a palliative regimen with growing utilization, but is still underutilized (only 7% of palliative regimens). The QUAD SHOT can be adapted to the patients’ response allowing patients still living and responding to receive more treatment and potentially live longer. An understanding and awareness of this option can help further improve utilization of this therapy and provide better palliation for head and neck patients.

Author Disclosure: J. Lorenz: None. R. Fain: None. J.R. Robbins: Travel Expenses; Elekta.

Joshua Lorenz, BS

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