Comparison between two radiation schedules in palliative radiotherapy of head and neck cancer

Background: Advanced head and neck cancers frequently present at incurable stages, where palliative radiotherapy is essential for symptom control. Conventional hypofractionated schedules often cause significant toxicity. Aims and Objectives: The aim of the study was to compare clinical outcomes of the QUAD SHOT regimen versus 30 Gy in 10 fractions in Stage III–IV head and neck cancer. Materials and Methods: In this prospective comparative study, 160 patients received either QUAD SHOT (14 Gy/4 fractions) or 30 Gy/10 fractions. Tumor response (RECIST), toxicity (Radiation Therapy Oncology Group), and quality of life (EORTC QLQ-H&N35) were assessed. Results: Most patients were male and >60 years. Grade 3 mucositis occurred in 37.5% with 30 Gy/10 fractions but was absent with QUAD SHOT (P<0.001). Grade 2 skin toxicity was absent in QUAD SHOT and seen in 3.75% with 30 Gy/10 fractions (P<0.001). Partial response rates were comparable (71.3% vs. 72.5%). Pain relief was superior with QUAD SHOT (35% vs. 11.3%, P<0.001). Conclusion: QUAD SHOT achieved similar tumor response with lower toxicity and improved pain relief, supporting its role as a well-tolerated palliative option in advanced head and neck cancer.