Objectives: Patients with recurrent and metastatic head and neck cancer (HNC) have limited treatment options. ‘QuadShot’ (QS), a hypofractionated palliative radiotherapy regimen, can provide symptomatic relief and local control and may potentiate the effects of immune checkpoint inhibitors (ICIs). We compared outcomes of QS ± concurrent ICIs in the palliative treatment of HNC. Materials and Methods: We identified patients who received ≥three cycles of QS from 2017 to 2022 and excluded patients without post-treatment clinical evaluation or imaging. Outcomes for patients who received QS alone were compared to those treated with ICI concurrent with QS, defined as receipt of ICI within 4 weeks of QS. Results: Seventy patients were included, of whom 57% received concurrent ICI. Median age was 65.5 years (interquartile range [IQR]: 57.9–77.8), and 50% patients had received prior radiation to a median dose of 66 Gy (IQR: 60–70). Median follow-up was 8.8 months. Local control was significantly higher with concurrent ICIs (12-month: 85% vs. 63%,p= 0.038). Distant control (12-month: 56% vs. 63%,p= 0.629) and median overall survival (9.0 vs. 10.0 months,p= 0.850) were similar between the two groups. On multivariable analysis, concurrent ICI was a significant predictor of local control (HR for local failure: 0.238; 95% CI: 0.073–0.778;p= 0.018). Overall, 23% patients experienced grade 3 toxicities, which was similar between the two groups. Conclusions: The combination of QS with concurrent ICIs was well tolerated and significantly improved local control compared to QS alone. The median OS of 9.4 months compares favorably to historical controls for patients with HNC treated with QS. This approach represents a promising treatment option for patients with HNC unsuited for curative-intent treatment and warrants prospective evaluation.
目的：复发转移性头颈癌（HNC）患者的治疗选择有限。"QuadShot"（QS）作为一种大分割姑息性放疗方案，可缓解症状并实现局部控制，且可能增强免疫检查点抑制剂（ICI）的疗效。本研究比较了QS联合或不联合同步ICI在HNC姑息治疗中的疗效。 材料与方法：我们筛选了2017年至2022年间接受≥3周期QS治疗的患者，排除治疗后未行临床评估或影像学检查者。将单独接受QS治疗的患者与在QS治疗4周内接受ICI治疗（定义为同步治疗）的患者结局进行对比。 结果：共纳入70例患者，其中57%接受同步ICI治疗。中位年龄65.5岁（四分位距[IQR]：57.9-77.8），50%患者曾接受中位剂量66 Gy（IQR：60-70）的既往放疗。中位随访时间8.8个月。同步ICI组的局部控制率显著更高（12个月：85% vs. 63%，p=0.038）。两组间远处控制率（12个月：56% vs. 63%，p=0.629）及中位总生存期（9.0 vs. 10.0个月，p=0.850）无显著差异。多变量分析显示，同步ICI是局部控制的独立预测因子（局部失败风险比：0.238；95% CI：0.073-0.778；p=0.018）。总体3级毒性发生率为23%，两组间无显著差异。 结论：与单纯QS治疗相比，QS联合同步ICI方案耐受性良好，并能显著改善局部控制。9.4个月的中位总生存期优于既往接受QS治疗的HNC患者历史数据。该方案为不适合根治性治疗的HNC患者提供了有前景的治疗选择，值得进行前瞻性评估。
肿瘤(癌症)患者之家