Annals of palliative medicine · 2026
The role of Quad Shot in palliative radiotherapy: narrative review of the evidence and applications in advanced head and neck cancer.
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Crompton David J, Mohammadi Homan, Wear Michelle A, Wert Katey M, Pirgousis Phillip, Patel Samip, Okuyemi Oluwafunmilola T, Janus Jeffrey R, Routman David M, Lester Scott C, Ma Daniel J, Patel Samir H, Zhao Yujie, Li Shenduo, Holtzman Adam L
Аннотация
BACKGROUND AND OBJECTIVE: Palliative radiotherapy (RT) plays a key role in managing advanced, recurrent, and metastatic head and neck cancers (HNCs), aiming to relieve symptoms and improve quality of life (QOL). The Quad Shot (QS) regimen, delivering 14.0 to 14.8 Gy in 4 fractions over 2 days repeated every 3 to 4 weeks, has emerged as an attractive treatment option. This review evaluates the efficacy, toxicity, and convenience of QS compared to other palliative RT regimens.
METHODS: We performed a narrative review of published literature on QS and other palliative RT regimens for HNC. Studies evaluating symptom relief, tumor response, toxicity profiles, and treatment logistics were included.
KEY CONTENT AND FINDINGS: QS achieves rapid symptom relief with minimal toxicity, with reported partial or complete response rates of 60% to 85% and palliative symptom control in over 70% of patients. Compared to conventional and stereotactic regimens, QS offers shorter treatment duration, favorable tolerance, and repeatability. Two case reports are described in this review, and appropriate patient selection, institutional target volume definitions, prescription doses, and recommended dose constraints are discussed. Future directions of QS include combination immunotherapy, minibeam RT, personalized ultrafractionated stereotactic adaptive RT, and reirradiation with particle therapy (e.g., proton and carbon ion).
CONCLUSIONS: The QS regimen is an effective, convenient, and well-tolerated palliative RT approach for advanced HNC, particularly for patients with significant comorbid conditions or poor prognosis. Ongoing studies will clarify the role of QS alongside systemic therapies and advanced technologies.
METHODS: We performed a narrative review of published literature on QS and other palliative RT regimens for HNC. Studies evaluating symptom relief, tumor response, toxicity profiles, and treatment logistics were included.
KEY CONTENT AND FINDINGS: QS achieves rapid symptom relief with minimal toxicity, with reported partial or complete response rates of 60% to 85% and palliative symptom control in over 70% of patients. Compared to conventional and stereotactic regimens, QS offers shorter treatment duration, favorable tolerance, and repeatability. Two case reports are described in this review, and appropriate patient selection, institutional target volume definitions, prescription doses, and recommended dose constraints are discussed. Future directions of QS include combination immunotherapy, minibeam RT, personalized ultrafractionated stereotactic adaptive RT, and reirradiation with particle therapy (e.g., proton and carbon ion).
CONCLUSIONS: The QS regimen is an effective, convenient, and well-tolerated palliative RT approach for advanced HNC, particularly for patients with significant comorbid conditions or poor prognosis. Ongoing studies will clarify the role of QS alongside systemic therapies and advanced technologies.