# Impact of stomatitis on pain relief and nutrition in palliative radiotherapy using quad shot: a prospective study

## TL;DR

This study shows that Quad Shot radiotherapy reduces tumor pain in head and neck cancer but worsens stomatitis, affecting nutrition and requiring careful management.

## Contribution

The study is the first to separately evaluate tumor and stomatitis pain in Quad Shot radiotherapy for head and neck cancer.

## Key findings

- Tumor pain significantly improved with increased Quad Shot treatment duration.
- Stomatitis pain worsened significantly after treatment, impacting patients' nutrition as shown by decreased albumin levels.
- Quality of life scores remained unchanged, but stomatitis management is critical for maintaining patient well-being.

## Abstract

Quad Shot (QS) is effective in treating head and neck cancer; however, few prospective studies have been conducted in this direction. Further, no studies have investigated tumor pain and stomatitis pain separately. We prospectively investigated the efficacy and adverse events of QS in 11 patients with head and neck cancer who underwent QS at our hospital in Japan between 2018 and 2024. The QS method involved administering 3.7 Gy twice daily for 2 days, which was considered one course and provided thrice at an interval of 4 weeks. We assessed quality of life (QOL) scores, albumin levels, and numerical rating scale (NRS) scores for stomatitis and tumor pain before and after QS to evaluate changes in NRS. Eleven patients with advanced head and neck cancer received QS treatment: six patients underwent three courses, three underwent two, and two underwent one. There was no significant difference in QOL scores before and after QS, but albumin levels dropped significantly after QS. NRS due to stomatitis significantly worsened after QS, whereas NRS due to tumor significantly improved. Tumor size decreased and tumor NRS improved as the QS treatment duration increased. However, stomatitis was almost always present, and NRS scores for stomatitis increased significantly after treatment. In conclusion, QS can alleviate tumor pain but may worsen stomatitis. Therefore, stomatitis care should be emphasized during treatment. Furthermore, the decrease in albumin levels is likely due to stomatitis-induced decreased appetite; therefore, stomatitis management is also important for maintaining nutritional status.