S923
Clinical - Mixed sites & palliation
ESTRO 2026
and the last available imaging. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method. Results: The cohort included six head and neck cancers, eight non-melanoma skin cancers, two cancers of unknown primary, and three other malignancies (breast, lung, and urothelial), mostly superficial lesions (n = 18). The median age was 76 years (range 49 – 97). Three, two, and one QS cycles were completed by 44.4 % (n = 8), 33.3% (n = 6), and 22.2 % (n = 4) of patients, respectively. We observed no ≥ Grade 3 acute or late toxicity. At least one symptom relief was obtained in 13 (72.2 %) patients, the most common symptom was pain. Mean GTV decreased from 229.1 ± 184.1 cc at the first QS cycle to 136.6 ± 98.1 cc (40.4 % reduction) at the second and 57.6 ± 27.6 cc (74.9 % reduction) at the third cycle, with a statistically significant difference across cycles (ANOVA, p = 0.001, Figure 1). Local control was achieved in 13 patients (72.2 %). An overall clinical benefit (tumor response or symptom relief) was observed in 15 patients (83.3 %), including all who completed three cycles. Median OS was 8.8 months (95 % CI 2.5 - not reached) and median PFS was 4.3 months (95 % CI 2.4 - not reached)(Figure 2). The number of QS cycles was an independent prognostic factor for both improved OS and PFS (p < 0.001).
Figure 2. Conclusion:
QS was a safe and well-tolerated palliative radiotherapy regimen, feasible even in elderly patients. Meaningful clinical responses and symptom relief were observed, particularly in those completing multiple QS cycles. These results support the use of QS with modern intensity-modulated techniques suggesting the regimen’s relevance in contemporary palliative radiotherapy practice. References: Corry J, Peters LJ, D'Costa I, Milner AD, Fawns H, Rischin D, Porceddu S. The ‘QUAD SHOT’ - a phase II study of palliative radiotherapy for incurable head and neck cancer. Radiotherapy and oncology. 2005 Nov 1;77(2):137-42.Lok BH, Jiang G, Gutiontov S, Lanning RM, Sridhara S, Sherman EJ, Tsai CJ, McBride SM, Riaz N, Lee NY. Palliative head and neck radiotherapy with the RTOG 8502 regimen for incurable primary or metastatic cancers. Oral oncology. 2015 Oct 1;51(10):957-62.O'Donovan A, Morris L. Palliative radiation therapy in older adults with cancer: age- related considerations. Clinical Oncology. 2020 Nov 1;32(11):766-74. Keywords: Quad shot, palliation, hypofractionation
Figure 1. Red- 3QS cycles, Blue- 2QS cycles
Digital Poster 4642 Palliative radiotherapy in ECOG PS 3-4: large-cohort outcomes with ultra-short fractionation
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