For decades, the Quad Shot regimen has provided a common-sense strategy to palliate symptomatic tumors in an extremely low-burden yet potentially durable manner. In this Japanese prospective cohort, 48 patients with stage III–IV head and neck squamous cell carcinoma ineligible for curative therapy received the Quad Shot regimen: 3.5-3.7 Gy x 4 = 14–14.8 Gy delivered twice-daily over two consecutive days for up to 3 cycles at 3-6-week intervals. The population skewed elderly (median age 81) with high disease burden (60% T4, 88% with distant mets). The primary endpoint of completion rate for all three cycles was an impressive 81%. What’s more, 80% of patients had stable or improved quality of life at 3 months. The authors attribute this to the use of modern techniques with two-thirds receiving IMRT and the remaining 3D-conformal radiation. | Toya, Pract Radiat Oncol 2026
