# Palliative expeditiously adaptive quad shot radiotherapy for head and neck cancers (PEAQ-RT)

## TL;DR

A new radiotherapy workflow reduces the need for extra CT scans and travel for head and neck cancer patients.

## Contribution

A feasible online adaptive radiotherapy workflow (PEAQ-RT) eliminates extra simulation visits for quad shot radiotherapy.

## Key findings

- PEAQ-RT workflow was feasible in 87.5% of patients receiving at least one adapted cycle.
- The workflow saved a median of 50.8 miles in travel distance and 3.5 hours in travel time per patient.

## Abstract

•Quad shot is a safe and effective treatment for advanced head and neck cancer.•Additional appointments between cycles can be onerous for this patient population.•CT-guided online adaptive workflow (PEAQ-RT) eliminates extra simulation visits.•PEAQ-RT is feasible and reduces both travel distance and time burdens for patients.

Quad shot is a safe and effective treatment for advanced head and neck cancer.

Additional appointments between cycles can be onerous for this patient population.

CT-guided online adaptive workflow (PEAQ-RT) eliminates extra simulation visits.

PEAQ-RT is feasible and reduces both travel distance and time burdens for patients.

Quad shot radiotherapy (QS-RT) is integral to head and neck cancer palliative care, but multiple CT-simulations for QS-RT cycles can be burdensome for patients. We evaluated the ability of an online adaptive radiotherapy (ART) workflow (PEAQ-RT) to eliminate extra CT simulations in QS-RT and reduce treatment related burdens.

Ten patients with head and neck malignancies were enrolled in this prospective study receiving QS-RT for up to three cycles, each comprising four fractions of 350 cGy delivered twice daily, with a total dose of 1400 cGy per cycle. QS-RT could be delivered up to three cycles, spaced three to four weeks apart. Patients underwent standard CT simulation, and the simulation plan served as the treatment plan for the first QS-RT cycle. For subsequent QS-RT cycles, patients proceeded directly to adaptive treatment via institutional online ART protocol. Feasibility was defined as completing this expedited adaptive QS-RT workflow in at least 80 % of attempted adapted fractions.

Ten patients aged 56–89 were enrolled. Eight patients received a second cycle of QS-RT and four patients received a third cycle. PEAQ-RT workflow was feasible in 87.5% (7/8) of patients who received at least one adapted cycle and was feasible in 86% (12/14) of attempted adapted fractions. For the second and third cycles, average total workflow time for the adaptive treatments was 28 min (14–38). All constraint violations were resolved with the use of online adaptation. The PEAQ-RT workflow eliminated a median of 2 (range: 0–2) simulation visits with additional QS-RT cycles. This resulted in a median travel distance savings of 50.8 miles (range: 40.6–848 miles) and a median reduction of 3.5 h in travel time per patient.

PEAQ-RT enabled QS-RT while eliminating the need for additional CT simulation appointments for subsequent cycles.