Efficacy of Quad Shot Radiation therapy for symptom palliation in Advanced and Metastatic Breast Cancer

Abstract

Background: Advanced and metastatic breast cancer often presents with debilitating symptoms such as pain and bleeding. Palliative radiotherapy aims to alleviate these symptoms. This quasi-experimental study compared the efficacy of Quad-shot radiation therapy (QS) to standard palliative radiotherapy (SOC) for symptom control in such patients. Methods: Conducted at the Combined Military Hospital, Rawalpindi, over six months, the study included 50 female patients with histopathologically confirmed invasive breast carcinoma, aged ≥18 years, with significant localized symptoms and ECOG PS 1-3. Patients were randomized into two groups: SOC (20 Gy in 5 fractions over one week) and QS (14.8 Gy in 4 fractions over two consecutive days, twice daily). Outcomes included pain relief (Numerical Rating Scale, NRS) and bleeding control (CTCAE criteria), assessed at baseline, one week, and three weeks post-treatment. Data were analyzed using paired t-tests, McNemar tests, or Wilcoxon signed-rank tests, with p < 0.05 considered statistically significant. Results: The median age was 48 years in the QS group and 50 years in the SOC group. Baseline NRS pain scores were 9.1 (QS) and 9.6 (SOC). Post-treatment, the QS group demonstrated a significantly greater reduction in pain (mean decrease: 3.7 vs. 2.1, p = 0.05). Bleeding episodes also decreased more in the QS group (mean change: 1.9 vs. 1.2 episodes, p = 0.05). Both regimens achieved effective symptom control, with QS showing superior outcomes in pain and bleeding resolution. Conclusion: Quad-shot radiotherapy is an effective and efficient alternative to standard palliative radiotherapy, offering superior symptom relief for pain and bleeding in patients with advanced or metastatic breast cancer. Further studies with larger sample sizes are warranted to validate these findings.