Comparative Evaluation of Octa Shot Versus Quad Shot Palliative Radiotherapy for Advanced Head and Neck Cancer Patients

Background: Majority of Head and Neck Squamous Cell Cancer patients in India present in advanced stages. They are not candidates for multimodality treatment due to loco-regionally advanced disease and poor performance status. Hypo-fractionated regimens have been used for palliation of advanced head and neck cancers. Purpose: The purpose of this study to compare the acute and late toxicity and overall response of octa shot and quad shot radiation therapy as palliative regime in locally advanced head and neck cancers.Materials and methods: A hospital based prospective, randomized study was conducted with 50 patients of advanced Squamous cell carcinoma of head and neck, 25 patients taken in each arm. Two fractions(3.5Gy/#) per day six hours apart was given in four consecutive days (Octa shot). Two fractions (3.5Gy/#) per day six hours apart was given in two consecutive days repeated for one more cycle with a interval of two weeks (Quad shot). Acute toxicities monitored at day 15 &30 and late at 3 & 6 months after the treatment started. Results: Octa shot had slightly better loco-regional control but the difference was statistically insignificant. Octa shot had more grade 2 skin and mucosal reaction than Quad shot. Symptomatic relief, subjective regression and improved QOL were better in Octa shot than Quad shot. Conclusion: The study concludes that “octa shot” is an effective palliative radiotherapy regime with greater yet manageable toxicity in comparison to Quad shot regimen. This regime not only strikes a balance between the economic burden, treatment time, machine load but also helps in selecting patients for further dose escalation based on treatment response and symptomatic relief. However more such trials with longer follow up and larger sample size are required for stronger evidences.