Quad Shot Palliation, A Considerable Option for Non-Osseous Recurrent or Metastatic Malignancies in Elderly or Frail Patients.

Main Article Content

Saif Ur Rehman
Shafaq Maqsood
Aneela Deevan

Abstract

Background: Palliative radiation therapy (RT) is increasingly recognized as a crucial component of care for patients with advanced, incurable malignancies. In Pakistan, where patients often present at advanced stages due to socio-economic barriers and limited healthcare access, efficient and effective treatment protocols are essential.


Objective: This study aimed to evaluate the efficacy of the Quad Shot hypo-fractionated RT protocol for pain palliation in elderly and frail patients with recurrent or metastatic non-osseous malignancies.


Methods: A quasi-experimental study was conducted at the Oncology Department of Ganga Ram Hospital, Lahore. Forty-two elderly patients with histologically confirmed inoperable malignancies and a WHO Performance Status of 2 to 3 were enrolled. Patients with prior RT or a second cancer were excluded. RT was delivered using a Cobalt-60 beam, with a total dose of 14 Gy divided into four fractions over two consecutive days. Pain severity was assessed using a 10-point scale before and four weeks after treatment. Statistical analysis was performed using the Wilcoxon Sign Rank Test on SPSS version 25.0.


Results: The study population comprised 52% males and 48% females, with the majority of primary tumors located in the head and neck (64%). Post-treatment, the mean pain score significantly decreased from 8.04 ± 1.22 to 4.32 ± 0.89 (p < 0.05).


Conclusion: The Quad Shot hypo-fractionated RT protocol effectively reduces pain in elderly and frail patients with advanced malignancies, suggesting its suitability as a quick and effective palliative care option in resource-limited settings.

Article Details

How to Cite
Saif Ur Rehman, Shafaq Maqsood, & Aneela Deevan. (2024). Quad Shot Palliation, A Considerable Option for Non-Osseous Recurrent or Metastatic Malignancies in Elderly or Frail Patients. Journal of Health and Rehabilitation Research, 4(2), 456–460. https://doi.org/10.61919/jhrr.v4i2.873
Section
Articles
Author Biographies

Saif Ur Rehman, Ganga Ram Hospital Lahore Pakistan

Assistant Professor of Radiotherapy, Ganga Ram Hospital, Lahore, Pakistan

Shafaq Maqsood, Ganga Ram Hospital Lahore Pakistan

Senior Registrar, Oncology Department, Ganga Ram Hospital Lahore Pakistan

Aneela Deevan, Ganga Ram Hospital Lahore Pakistan

Medical Officer, Oncology Department, Ganga Ram Hospital Lahore Pakistan

References

Amichetti M, Orrù P, Madeddu A, Murtas R, Carau B, Farigu R, et al. Comparative Evaluation of Two Hypofractionated Radiotherapy Regimens for Painful Bone Metastases. Tumor. 2004;90:91-5.

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-49.

Porceddu SV, Rosser B, Burmeister BH, Jones M, Hickey B, Baumann K, et al. Hypofractionated Radiotherapy for the Palliation of Advanced Head and Neck Cancer in Patients Unsuitable for Curative Treatment – "Hypo Trial". Radiother Oncol. 2007;85(3):456-62.

Hartsell WF, Yajnik S. Palliation of Bone Metastases. In: Halperin EC, Perez CA, Brady LW, editors. Principles and Practice of Radiation Oncology. 5th ed. New York: Lippincott Williams & Wilkins; 2008. p. 1986-99.

Talapatra K, Gupta T, Agarwal JP, Laskar SG, Shrivastava SK, Dinshaw KA. Palliative Radiotherapy in Head and Neck Cancers: Evidence Based Review. Indian J Palliat Care. 2006;12:44-50.

Ali MY, Alam MS, Mannan MA, Asaduzzaman AK, Khan MA, Islam SM. Short Course Palliative Radiotherapy in Locally Advanced Squamous Cell Carcinoma of Head and Neck. JAFMC Bangladesh. 2010;6(1):16-20.

Restifo D, Raab G, McBride SM, Pfister DG, Wong RJ, Lee NY, Shahrokni A, Zakeri K. Correlation of an Electronic Geriatric Assessment With Receipt of Adjuvant Radiation and Chemotherapy in Older Adults With Head and Neck Cancer. Advances in Radiation Oncology. 2023 Jan 1;8(1):101096.

Maqsood T, Arif S, Ali U. Quad Shot-Hypofractionated Radiotherapy for Palliation in Advanced Squamous Cell Carcinoma of Head and Neck. Pak Armed Med J. 2017;67(2):222-5.

Agarwal JP, Nemade B, Murthy V, Ghosh-Laskar S, Budrukkar A, Gupta T, et al. Hypofractionated, Palliative Radiotherapy for Advanced Head and Neck Cancer. Radiother Oncol. 2008;89:51-6.

Singh S, Bisht N, Sarin A, Vashisht R, Lohia N, Gupta V, Trivedi G. Use of split-course hypofractionated radiotherapy in palliative treatment of head and neck cancers: how does our regimen compare with others?. Journal of Radiotherapy in Practice. 2023;22:e83.

Yamamoto A, Ieki H, Shimamura M, Tsujiura M, Yokoe T, Sanuki N, Ojima E, Uchida K, Mohri Y. Symptom palliation with QUAD Shot radiation therapy to penile metastasis derived from descending colon cancer: a case report. InInternational Cancer Conference Journal 2023 Jul (Vol. 12, No. 3, pp. 210-215). Singapore: Springer Nature Singapore.

Dickstein DR, Powers AE, Vujovic D, Roof S, Bakst RL. Clinical and therapeutic considerations for older adults with head and neck cancer. Clinical Interventions in Aging. 2023 Dec 31:409-22.

Corry JF, Peters LJ, D’Costa I. The "Quad Shot"- A Phase II Study of Palliative Radiotherapy for Incurable Head and Neck Cancer. Radiother Oncol. 2006;77:137-42.

Hilal A, Verma AK. A Prospective study to evaluate the response and quality of life with Quad shot Radiotherapy in locally advanced or Metastatic Head & Neck Cancer.

Caeiro L, Gandhay D, Anderson LJ, Garcia JM. A Review of Nutraceuticals in Cancer Cachexia. Cancers. 2023 Jul 30;15(15):3884.

Matos LL, Sanabria A, Robbins KT, Halmos GB, Strojan P, Ng WT, Takes RP, Angelos P, Piazza C, de Bree R, Ronen O. Management of Older Patients with Head and Neck Cancer: A Comprehensive Review. Advances in therapy. 2023 May;40(5):1957-74.

Mohanti BK, Umapathy H, Bahadur S, Pathy S. Short Course of Palliative Radiotherapy of 20 Gy in 5 Fractions for Advanced and Incurable: AIIMS Study. Radiother Oncol. 2004;71:275-80.

Vergas A. Single Dose Radiotherapy in Soft Tissue Tumoral Masses: Just Enough Palliation. Reports of Practical Oncology and Radiotherapy. 2020;25:64-67.

Chiu CT, Wang HP, Chen YY, editors. Atlas of Small Intestinal Disorders: Integrated Case Presentation. Springer Nature; 2023 Nov 30.

Chao B, Jiao J, Yang L, Wang Y, Yu T, Liu H, Zhang H, Li M, Wang W, Cui X, Du S. Comprehensive evaluation and advanced modification of polymethylmethacrylate cement in bone tumor treatment. Journal of Materials Chemistry B. 2023;11(39):9369-85.