S535
Clinical – Head & neck
ESTRO 2026
radiotherapy (RT) with or without concomitant chemotherapy (CT). Acute toxicity was assessed using the CTCAE v5.0 scale. L-glutamine was initiated at a median of 15 days prior to RT ± CT. The cohort included 82% men and 18% women, with a mean age of 62.5 years (range 37–88). Most patients had locally advanced disease (84%), squamous histology (86%), and primary tumor sites in the larynx (26.3%) and oral cavity (24.7%). The mean radiation dose was 66 Gy (range 57.5–69.96), and 70% received concomitant RT and CT. L-glutamine was well tolerated; only 4 patients required dose reduction due to metallic taste or mild itching. Median follow-up was 38 months. Results: Severe oral mucositis occurred in fewer than 28% of patients at the end of RT ± CT. By one month post- treatment, only 3% of patients continued to experience severe mucositis, and no cases were observed by the third month (see Graphic-1). Nearly half of the patients (43%) required major opioid analgesics for pain management, initiated at a median cumulative radiation dose of 40 Gy. Hospital admission was necessary in only eight patients due to treatment-related complications. Conclusion: The administration of glutamine during radiotherapy (RT), with or without concomitant chemotherapy (CT), in patients with head and neck cancer (HNC) appears to mitigate both the severity and duration of treatment-induced mucositis. This intervention may consequently reduce the reliance on opioid analgesics, support adherence to oncologic treatment protocols, and enhance patient-reported quality of life. However, these observations remain preliminary, and robust, randomized controlled trials are required to validate these effects, determine optimal dosing strategies, and clarify potential mechanistic pathways. References: Xia, J. (2025).Consenso de expertos sobre la prevención y tratamiento de la mucositis oral inducida por radioterapia y quimioterapia en pacientes con cáncer de cabeza y cuello.Supportive Care in Cancer, 33(1), 1–10.Peng, T. R. (2021).Eficacia de la glutamina en la prevención de la mucositis oral inducida por quimioterapia o radioterapia: un metaanálisis de ensayos clínicos controlados.Head & Neck, 43(10), 3199–3213.Fatima, K. (2024).Oral glutamine: ¿tiene un papel en la mejora de la mucositis oral inducida por radioterapia?Cancer Journal, 30(1), 19–25. Keywords: Glutamine,Mucositis,Head and Neck Cancer (HNC)
Emerging evidence also highlights that HPV-positive tumors exhibit higher α / β ratios, genomic stability, and non-infiltrative spread patterns, supporting their intrinsic radiosensitivity and rationale for safe dose reduction. Conclusion: Radiotherapy dose de-escalation in HPV-positive OPSCC offers promising oncologic outcomes with significantly reduced treatment morbidity and improved quality of life. However, not all HPV-positive patients are suitable; those with adverse features (extensive ENE, high tumor volume, heavy smoking) require standard-dose therapy. Future directions include biomarker-guided, imaging-adaptive, and genomic-risk–based protocols to optimize individualized treatment intensity. References: Nichols AC, et al. Phase II trial of transoral surgery and low-dose intensity-modulated radiation therapy for HPV-related oropharyngeal squamous cell carcinoma (E3311). J Clin Oncol. 2021;39(9):956–965.Yom SS, et al. Reduced-dose radiation therapy for HPV-associated oropharyngeal carcinoma (NRG-HN002): a randomized phase II trial. J Clin Oncol. 2021;39(9):956–965.Ferris RL, et al. NRG-HN005: Phase II/III trial of reduced-dose radiation therapy ± immunotherapy for HPV-positive oropharyngeal carcinoma. J Clin Oncol. 2024;42(Suppl 16):5500.Ma DJ, et al. Phase II evaluation of aggressive dose de-escalation for adjuvant chemoradiotherapy in human papillomavirus–associated oropharynx squamous cell carcinoma (MC1273). Keywords: HPV, oropharyngeal cancer, de- intensification Digital Poster 336 Fighting Oral Mucositis in Radiotherapy: The Power of L-Glutamine Supplementation maria cristina cruz muñoz, ana torres garcia, isabel maria Pérez rodríguez, francisco jose peracaula espino Radiation Oncology, Hospital Punta Europa, Algeciras, Spain Purpose/Objective: The main objective of this study was to evaluate the use of oral L-glutamine in routine clinical practice to prevent and reduce severe oral mucositis in patients with head and neck cancer (HNC) undergoing radiotherapy. As a secondary objective, we assessed its effect on the need for major opioid analgesics used for mucositis-related pain control. Material/Methods: From November 2018 to March 2025, 94 patients with head and neck cancer (HNC) treated at our center were retrospectively analyzed. All patients received oral L-glutamine (14 g every 8 hours per day) during
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