Background
Single-arm prospective series validating the QUAD SHOT hypofractionated palliative RT regimen. 57 patients with advanced, symptomatic NSCLC (stages IIIB–IV, poor PS, not candidates for definitive CRT). Received QUAD SHOT: 14 Gy in 2 fractions per day for 2 consecutive days (total 14 Gy per course), repeated every 4 weeks for up to 3 courses (total 42 Gy). Aimed to palliate thoracic symptoms while allowing systemic therapy continuation.
Interventions and follow up
Arm A: QUAD SHOT: 3.5 Gy × 4 fractions over 2 consecutive days q4 weeks × 3 courses; total 42 Gy (if 3 courses completed)
Primary endpoint: Symptom response (dyspnea, cough, hemoptysis, pain)
mFollow up: 6 month
Primary endpoint: Symptom response (dyspnea, cough, hemoptysis, pain)
mFollow up: 6 month
Results
Symptom response rate: 68% (any symptom improvement)
Dyspnea improvement: 64%; hemoptysis improvement: 85%
mOS: 4.7 months; 1-year OS 20%
Grade ≥3 esophagitis: 5% (course 1) — well tolerated
Dyspnea improvement: 64%; hemoptysis improvement: 85%
mOS: 4.7 months; 1-year OS 20%
Grade ≥3 esophagitis: 5% (course 1) — well tolerated
Adverse events
Main adverse events: Grade ≥2 esophagitis: 15% per course, manageable. Fatigue: 30% grade 2. No grade ≥3 pulmonary toxicity. Grade ≥3 esophagitis: 5%. Regimen well-tolerated in PS 2–3 patients. No treatment-related deaths.
Conclusions
The QUAD SHOT regimen (3.5 Gy × 4 fractions over 2 days) achieves meaningful symptom palliation in poor-PS advanced NSCLC patients with acceptable toxicity and allows repeated courses. It is a practical palliative option for patients who cannot tolerate conventional multi-week RT schedules.
Key Limitations
Key Limitations: Single-arm; no comparator. Short OS (4.7 months) limits assessment of late effects or tumor control. Heterogeneous symptom assessment. QUAD SHOT BED (α/β=10) is relatively low (~30 Gy equivalent) — not appropriate where higher BED is needed for local control.
Clinical Context
QUAD SHOT is a widely used palliative RT regimen for advanced thoracic malignancy in poor-PS patients. It allows outpatient treatment over 2 consecutive days and can be repeated. Alternative short-course regimens (17 Gy/2, 20 Gy/5) are also standard. Selection between schedules depends on PS, expected survival, and symptom urgency.
References