Fan Dan, Kang Jung J, Fan Ming, Wang Huili, Lee Anna, Yu Yao, Chen Linda, Jillian Tsai C, McBride Sean M, Riaz Nadeem, Gelblum Daphna Y, Neal Brian P, Fetten James, Dunn Lara A, Michel Loren S, Boyle Jay O, Cohen Marc A, Roman Benjamin R, Ganly Ian, Singh Bhuvanesh, Wong Richard J, Sherman Eric J, Lee Nancy Y
Department of Radiation Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Oral Oncol. 2020 May;104:104641. doi: 10.1016/j.oraloncology.2020.104641. Epub 2020 Mar 14.
Patients with prior irradiated head and neck cancer (HNC) who are ineligible for definitive retreatment have limited local palliative options. We report the largest series of the use of the Quad Shot (QS) regimen as a last-line local palliative therapy.
We identified 166 patients with prior HN radiation therapy (RT) treated with QS regimen (3.7 Gy twice daily over 2 consecutive days at 4 weeks intervals per cycle, up to 4 cycles). Palliative response defined by symptom(s) relief or radiographic tumor reduction, locoregional progression free survival (LPFS), overall survival (OS) and radiation-related toxicity were assessed.
Median age was 66 years. Median follow-up for all patients was 6.0 months and 9.7 months for living patients. Overall palliative response rate was 66% and symptoms improved in 60% of all patients. Predictors of palliative response were > 2 year interval from prior RT and 3-4 QS cycles. Median LPFS was 5.1 months with 1-year LPFS 17.7%, and median OS was 6.4 months with 1-year OS 25.3%. On multivariate analysis, proton RT, KPS > 70, presence of palliative response and 3-4 QS cycles were associated with improved LPFS and improved OS. The overall Grade 3 toxicity rate was 10.8% (n = 18). No Grade 4-5 toxicities were observed.
Palliative QS is an effective last-line local therapy with minimal toxicity in patients with previously irradiated HNC. The administration of 3-4 QS cycles predicts palliative response, improved PFS, and improved OS. KPS > 70 and proton therapy are associated with survival improvements.
既往接受过头颈部癌（HNC）放疗但不符合再次根治性治疗条件的患者，其局部姑息治疗选择有限。我们报告了最大规模的关于使用四联注射（QS）方案作为一线局部姑息治疗的系列研究。
我们确定了166例既往接受过头颈部放疗（RT）并接受QS方案治疗的患者（每周期连续2天，每天两次，每次3.7 Gy，间隔4周，最多4个周期）。评估了由症状缓解或影像学肿瘤缩小所定义的姑息反应、局部区域无进展生存期（LPFS）、总生存期（OS）以及放疗相关毒性。
中位年龄为66岁。所有患者的中位随访时间为6.0个月，存活患者为9.7个月。总体姑息反应率为66%，所有患者中有60%的症状得到改善。姑息反应的预测因素为距既往放疗间隔>2年以及3 - 4个QS周期。中位LPFS为5.1个月，1年LPFS为17.7%，中位OS为6.4个月，1年OS为25.3%。多因素分析显示，质子放疗、KPS>70、存在姑息反应以及3 - 4个QS周期与改善的LPFS和OS相关。总体3级毒性发生率为10.8%（n = 18）。未观察到4 - 5级毒性反应。
姑息性QS是一种有效的一线局部治疗方法，对既往接受过放疗的HNC患者毒性最小。给予3 - 4个QS周期可预测姑息反应、改善无进展生存期（PFS）和总生存期（OS）。KPS>70和质子治疗与生存期改善相关。
