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• W2972696397 abstract "Patients with recurrences in the previously radiated head and neck (HN) have limited palliative options and poor outcomes. Organ dysfunction and ≤2 year interval from prior radiation therapy (RT) can identify poor candidates for definitive reirradiation. We report the largest series of the use of the Quad Shot (QS) regimen as a last-line local treatment for patients with prior HN RT who are incurable and ineligible for definitive salvage. From 2010 to 2018, 101 patients had locally recurrent HN tumors which were incurable and ineligible for definitive reirradiation as local salvage therapy. All had received prior HN RT (median dose 60 Gy, IQR 60-70) and 21% had received two or more prior courses of HN RT; the majority (n=60) were sent within 2 years of prior RT. Patients received palliative QS (3.7 Gy twice daily over 2 consecutive days at 4 week intervals per cycle, up to 4 cycles). Most had unresected gross disease (n=82) and were sent prior to hospice referral. Clinical characteristics were analyzed and overall survival (OS) was calculated from the start of QS. Palliative response and toxicities will be reported at a later time. Median age was 67 years (range 23-101) and 39% had KPS ≤60 (n=39). Subsites included nasal cavity/paranasal sinuses/nasopharynx (n=14), oral cavity (n=31), oropharynx (n=18), larynx/hypopharynx (n=14), skin (n=14), and other (n=10 including orbit, thyroid, salivary glands). Histologies included squamous cell (n=78), salivary (n=10), and other (n=13 including adenocarcinoma, basal cell, melanoma, Merkel cell, neuroendocrine, sarcoma, thyroid). Most patients were not metastatic (n=61), and nearly half (n=46) had organ dysfunction (tracheostomy and/or peg tube due to cancer-related symptoms). Median OS was 5.6 months (IQR 2.3-8.6), with 1 year OS 18.6% (95% CI 11.5-30%). KPS≥70 strongly predicted OS (median 6.7 vs. 4.3 months, p=0.012). On univariate analysis, there were trends for associations between OS with increasing number of QS cycles (median OS: 4.0 months, 1-2 cycles vs. 7.0 months, 3-4 cycles, p=0.058), >2 year interval from prior RT (6.3 vs. 4.3 months, p=0.071), and organ dysfunction (4.3 vs. 6.0 months, p=0.081). OS was not associated with concurrent systemic therapy (n=39, p=0.69) or surgical resection prior to QS (n=19, p=0.57). On multivariate Cox regression, only KPS≥70 (HR 0.51, 95%CI 0.31-0.84, p=0.007) and QS 3-4 cycles (HR 0.58, 95% CI 0.36-0.94, p=0.027) independently predicted OS. Prior HN RT patients who are incurable or ineligible for definitive local salvage may benefit from QS. Unlike in the definitive reirradiation setting, organ dysfunction and ≤2 year interval from prior RT are not necessarily deterrents to a trial of QS as a last-line local therapy. There appears to be a survival benefit to the administration of more cycles of QS, with no benefit of concurrent systemic therapy or surgical resection prior to QS." @default.
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• W2972696397 date "2019-09-01" @default.
• W2972696397 modified "2023-09-23" @default.
• W2972696397 title "Last-line Treatment with the Quad Shot Regimen for Previously Irradiated Head and Neck Cancers" @default.
• W2972696397 doi "https://doi.org/10.1016/j.ijrobp.2019.06.1589" @default.
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