S2666
RTT - Patient experience and quality of life
ESTRO 2026
Cowppli-Bony A. Santé Publique France. 2013.3. Machiels JP, et al. Ann Oncol. 2020;31:1462 - 75.4. Mody MD, et al. Lancet. 2021;398:2289 - 99.5. Dhull AK, et al. World J Oncol. 2018;9:80 - 4.6. Ohri N, et al. Int J Radiat Oncol Biol Phys. 2015;91:232 - 8.7. Ferreira BC, et al. Clin Transl Oncol. 2016;18:677 - 84.8. Palwe V, et al. J Radiother Pract. 2020;19:359 - 64.9. Nutting C, et al. Lancet Oncol. 2023;24:868 - 80.10. Garabige V, et al. Cancer Radiother. 2007;11:111 - 6. Keywords: HNC neoplasm, Adherence, Prognostic factors Digital Poster 2489 Patient Experience and Workflow Impact of Non- Permanent Marks in Breast Radiotherapy Grace Lee 1,2 , Areeb Hassan 1 , Tara Rosewall 1,2 , Xiang Y Ye 1 , Amy Liu 1 , Yat Tsang 1,2 , Jennifer Croke 1,2 1 Radiation Medicine Program, Princess Margaret Cancer Centre, UHN, Toronto, Canada. 2 Department of Radiation Oncology, University of Toronto, Toronto, Canada Purpose/Objective: Non-permanent marks (NPM) offer an alternative for patients who prefer to avoid tattoos for breast radiotherapy (RT) planning. However, the clinical and patient-reported impact of NPM optionsremain underexplored.We evaluated pati ent experiences and workflow considerations of two NPM approaches in breast RT. Material/Methods: Consecutive English-speaking patients undergoingwhole breast RT planning with NPMs were approached to complete surveys at CT simulation (CTSim), 2- weeks post-RT (2W), and 3-months post-RT (3M). The surveyscollected patient characteristics,satisfaction, and experience with NPMsusing a scale of 0 (None) to 10 (Extreme). Clinical workflow impact was assessed by marking time and reapplication rates by radiation therapists at CT Sim and the treatment unit. Descriptive statistics summarizedsurvey responses. Free text comments about NPMs included in all surveys were analyzed for common themes. Results: From May 2024 to Jan 2025, 68 patients had NPMs: 37 with semi-permanent plant- based ink marks(NPM-Ink) and 31 withprotective covers applied over non-permanent setup marks (NPM-Cover). In the NPM-Ink group, surveys were completed by 30 (81%) at CTSim, 28 (76%) at 2W and 26 (70%) at 3M. For NPM-Cover group, surveys were completed by 30 (97%) at CTSim, 27 (87%) at 2W and 26 (84%) at 3M.At CT-Sim, median satisfaction scores with
IMRT for head and neck cancer between October 2017 and March 2022. Patients treated with non-IMRT techniques, palliative RT, reirradiation, or who declined data use were excluded. All patients underwent standardized treatment planning and follow-up, including regular clinical and imaging assessments. The primary endpoint was OS. Secondary endpoints included late toxicity and treatment adherence. Non-adherence was defined as missing more than two consecutive RT sessions for non-medical reasons. Survival analyses were performed using Kaplan–Meier estimates and Cox proportional hazards models. Results: A total of 342 predominantly male patients (median age 63 years) with mainly locally advanced squamous cell carcinomas of the oropharynx, hypopharynx/larynx, or oral cavity were included; most received either concurrent chemoradiotherapy or surgery followed by RT. Among them, 84 (24.6%) missed at least two consecutive treatment sessions for non-medical reasons. The 5-year OS rate for the entire cohort was 47.4% (95% CI: 45.6–57.1). Non-adherent patients had significantly worse OS compared with adherent patients (25.1% [16.8–37.4] vs. 54.7% [48.8– 61.2], p<0.01) (Figure 1). In multivariate analysis, non- adherence independently predicted poorer OS (HR 2.01, 95% CI: 1.45–2.78, p<0.01), with detrimental effects evident within the first year of follow-up. Severe toxicities (grade ≥ 3) occurred in 68 patients (19.9%), with no significant difference between adherent (21.7%) and non-adherent (14.3%) groups.Figure 1: Kaplan–Meier overall survival curves according to treatment adherence
Conclusion: Non-adherence to RT is an independent prognostic factor associated with reduced overall survival in patients with head and neck cancer treated with IMRT. Early identification of patients at risk of treatment interruption, and implementation of targeted supportive interventions including social, psychological, and logistical support are essential to optimize adherence and improve oncologic outcomes in the era of precision RT. References: 1. Bray F, et al. CA Cancer J Clin. 2024;74:229 - 63.2.
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