Neoadjuvant QUAD Shot as Temporizing Measure Prior to Definitive Surgery for Locally Advanced Oral Cavity Cancer

Abstract

<h3>Purpose/Objective(s)</h3> The mainstay of treatment for oral cavity cancer is surgery, often with adjuvant therapies if necessary. However, given issues involving prolonged workup or scheduling of surgery, treatment delays are inevitable. We aim to evaluate the utilization of a temporizing hypofractionated course of radiation therapy in the form of a Quad Shot prior to planned surgery for head and neck cancers. <h3>Materials/Methods</h3> Eighteen patients with a primary head and neck malignancy, predominantly locally advanced oral cavity cancers, received radiation therapy in the form of a Quad Shot from June 2016 to July 2021. External beam radiation therapy was delivered to the site of primary disease over 2 days, with 2 fractions per day given at least 6 hours apart. Total dose delivered ranged from 1400cGy to 1500cGy. Out of the 18 patients, 12 (66.7%) went on to receive surgery. The remaining patients either passed away prior to planned surgery or went on to receive definitive chemoradiation or palliation. American Joint Committee on Cancer (AJCC) clinical and pathological stage groups were recorded for each patient. <h3>Results</h3> Out of the 12 patients who received surgery, 1 patient (5.6%) had complete response to the dose of temporizing radiation with no pathological disease seen at surgery. Four patients (22.2%) had a partial response as defined as downstaging on final pathology. No response was seen in 11 patients (61.1%), and 2 patients (11.1%) had progression of disease as defined as upstaging on final pathology. The Quad Shot was overall well tolerated with no recorded adverse effects. Eight patients (44.4%) received adjuvant radiation +/- chemotherapy following surgery. <h3>Conclusion</h3> Discrepancies between clinical staging and pathological staging are common and expected. However, a quarter of our patients experienced downstaging following a temporizing Quad Shot. This raises the question of whether neoadjuvant radiation therapy is a viable option to temporize tumor growth while awaiting a surgery for head and neck cancers.