Proton Radiotherapy for Recurrent or Metastatic Head and Neck Cancers with Palliative Quad Shot.

Jennifer Ma,Eric J Sherman,Sean M Mcbride,Marina Shcherba,Han Xiao,Stanley I Gutiontov,Benjamin H Lok,Xin Cai,Chiaojung Jillian Tsai,Oren Cahlon,Nadeem Riaz,Jingfeng Zong,Andrew C Bell,Nancy Y Lee

doi:10.14338/ijpt-18-00003.1

Abstract

Some patients with previously treated, unresectable, recurrent or metastatic head and neck malignancies are not amenable to curative-intent treatment. Here, we investigated the quad-shot (RTOG 8502) regimen of hypofractionated proton radiotherapy (RT) in that patient population. From 2013 to 2015, 26 patients with recurrent or metastatic cancers were treated with palliative proton RT to the head and neck with quad shot (3.7 Gy twice daily for 2 days). Patient characteristics and survival data were reviewed. Seventeen (65%) patients received ≥ 3 quad-shot cycles and 23 (88%) had prior head and neck RT. Overall palliative response was 73% (n = 19). The most common presenting symptom was pain (50%; n = 13), which improved in 85% (n = 22) of all patients. The overall grade-1 acute-toxicity rate was 58% (n = 15), and no acute grade 3 to 5 toxicities were observed. The proton quad-shot regimen demonstrates favorable palliative response and toxicity profile, even in patients that received prior RT.

Highlights

Appropriate management of previously treated, unresectable, recurrent or metastatic head and neck malignancies remain a clinical challenge [1]
We previously evaluated the combination of quad shot with intensity-modulated RT (IMRT) and demonstrated a comparable palliative response [5], with only 5% of patients experiencing grade 3 to 4 acute toxicities
Treatment toxicity, and survival of patients with incurable, recurrent or metastatic head and neck malignancies treated with palliative proton RT with quad shot

Summary

Introduction

Appropriate management of previously treated, unresectable, recurrent or metastatic head and neck malignancies remain a clinical challenge [1]. Full-dose external beam radiation (EBRT) with or without systemic therapy may offer a meaningful survival benefit (10%-48% at 2 years) at the expense of increased risk and degree of toxicity [2, 3]. Short-course hypofractionated RT has been considered more suitable than protracted, conventional-fractionation RT because it provides equivalent symptomatic improvement, tumor response, and survival outcomes while shortening overall treatment time and minimizing effects [5,6,7]. A variety of different hypofractionation schemes have been used clinically (from 2.5-8 Gy per fraction, to a total dose of 20-48 Gy), the quad shot regimen is believed to offer the best combination of efficacy, toxicity, and patient convenience [4, 8]

Methods

Results

Conclusion