We aimed to evaluate the outcomes of the Radiation Therapy Oncology Group 8502 “QUAD shot” regimen using volumetric modulated arc therapy (VMAT) for incurable head and neck cancer (HNC). We included 105 patients with HNC in the study, undergoing at least one QUAD shot regimen cycle. We planned the radiotherapy using VMAT with 6 MV photons. One QUAD shot cycle included 14.8 Gy in 4 fractions with at least 6-hour intervals over 2 consecutive days, repeated every 3–6 weeks up to 3 cycles. We completed 1, 2, and 3 cycles in 11 (10 %), 17 (16 %), and 77 (73 %) patients, respectively. We concurrently performed systemic therapy in 13 (12 %) patients. Tumor response was observed in 92 (88 %) patients and at least one symptom relief in 51 (71 %) of 72 patients. We observed an overall response (tumor response or symptom relief) in 98 (93 %) patients with all patients who completed 3 cycles achieving it. The median overall survival (OS) was 6.8 months. Our multivariate analysis revealed that non-squamous cell carcinoma (p < 0.001), T category of 0–2 (p = 0.021), and 3 QUAD shot cycles (p < 0.001) were independent prognostic factors of better OS. We observed Grade 3 toxicity in 2 (2 %) patients while no ≥ Grade 4 acute or ≥ Grade 3 late toxicity. The QUAD shot regimen using VMAT exerts appropriate palliative effect in patients with incurable HNC. Treatment with higher QUAD shot cycle number would be recommended for better treatment outcomes.

中文翻译：

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放射治疗肿瘤学组 8502 使用体积调制弧疗法治疗无法治愈的头颈癌的“QUAD shot”方案

我们的目的是评估放射治疗肿瘤学组 8502“QUAD shot”方案使用体积调制弧疗法 (VMAT) 治疗无法治愈的头颈癌 (HNC) 的结果。我们在研究中纳入了 105 名 HNC 患者，他们接受了至少一个 QUAD 注射方案周期。我们计划使用 6 MV 光子的 VMAT 进行放射治疗。一个 QUAD 照射周期包括 4 次照射 14.8 Gy，连续 2 天至少间隔 6 小时，每 3-6 周重复一次，最多 3 个周期。我们分别为 11 名 (10%)、17 名 (16%) 和 77 名 (73%) 患者完成了 1、2 和 3 个周期。我们同时对 13 名 (12%) 患者进行了全身治疗。在 92 名 (88%) 患者中观察到肿瘤缓解，72 名患者中有 51 名 (71%) 至少一种症状缓解。我们在 98 名 (93%) 患者中观察到总体缓解（肿瘤缓解或症状缓解），所有完成 3 个周期的患者均实现了总体缓解。中位总生存期 (OS) 为 6.8 个月。我们的多变量分析显示，非鳞状细胞癌 (p < 0.001)、T 类别 0-2 (p = 0.021) 和 3 个 QUAD 注射周期 (p < 0.001) 是更好 OS 的独立预后因素。我们在 2 名 (2%) 患者中观察到 3 级毒性，但没有 ≥ 4 级急性毒性或 ≥ 3 级晚期毒性。使用 VMAT 的 QUAD 注射方案对无法治愈的 HNC 患者发挥了适当的姑息作用。建议使用更高的 QUAD 注射周期数进行治疗，以获得更好的治疗结果。