S541
Clinical – Head & neck
ESTRO 2026
1 Department of Radiation Oncology, University of Toronto, Toronto, Canada. 2 Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada. 3 Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada. 4 Department of Medicine, University Health Network, Toronto, Canada Purpose/Objective: Older adults with head and neck cancer (HNC) face complex treatment decisions due to frailty, comorbidity, and both cognitive and functional decline. Radiotherapy (RT), especially with concurrent chemotherapy, increases risk of severe toxicity and treatment interruptions that compromise outcomes. Comprehensive geriatric assessment (CGA) evaluates health status and function, but the predictive value of individual CGA domains for RT-related failure and treatment de-escalation remains unclear. We aimed to identify CGA components and treatment recommendations most associated with treatment outcomes and unplanned RT interruption or termination. Material/Methods: We retrospectively analyzed HNC patients assessed in the Older Adults with Cancer Clinic (OACC) prior to curative-intent RT, at Princess Margaret Cancer Centre, Toronto, Canada from 2015-2025. Clinical variables, CGA domains (nutrition, cognition, mood, instrumental activities of daily living (IADLs)), VES-13 (vulnerable = 3+), Charlson Comorbidity Index (CCI), and treatment details were abstracted. Associations between CGA domains and outcomes (unscheduled RT interruption, grade 3-4 toxicity, metastasis, cancer-specific death) were tested using Fisher’s exact or chi-square tests. Modified Poisson regression estimated risk ratios (RR) for predictors of RT interruption and treatment outcomes. Results: Among 97 curative-intent patients (mean age 80.3 years; 30.9% female), median RT dose was 66 Gy over 33 fractions. The majority of this group was vulnerable by VES-13 standards (3+), had decreased physical function, and compromised nutrition. Conversely, over half of this group had low CCI score (< 3), normal mood and cognition, IADL-independent, and were deemed fit for definitive treatment (Table 1). Female sex predicted higher cancer-specific mortality (RR 2.14, 95% CI 1.08–4.25, p = 0.0397, median follow- up = 23.2 months). Patients recommended for treatment de-escalation who received definitive treatment were 2.7 × more likely to experience an unscheduled RT break (95% CI 1.38–5.35, p < 0.01). Tools like the VES-13, ECOG scale, and CCI had limited significance in predicting risk in our outcomes of interest, but may be underpowered (Figure 1).
with 79.52% male, 20.48% female. Overall, 36 patients (43.4%) were HPV positive, 34 patients (41%) were HPV negative, and status was unknown for 13 patients (15.6%). A temporal trend was observed: the proportion of confirmed HPV+ OPC cases demonstrated an increase from 31% in 2019 to 52% in 2022. Patients with HPV as a single risk factor exhibited a high rate of treatment response, achieving a Complete Response (CR) in 83% of cases (15 patients), compared to 57% in the group with any history of smoking (37 patients). This single-risk factor HPV+ group also demonstrated a 0% recurrence rate versus a 10% rate in the smoking-associated cohort. The median overall survival was 48 months. Regarding overall survival, those patients with HPV+ status (irrespective of smoking history) demonstrated a higher 30-month survival rate (84%) compared to patients whose sole risk factor was smoking (57%) (p = 0.0123). Furthermore, a difference in 30-month survival was observed based on smoking status among HPV-driven cases: smoking patients had a survival rate of 61%, whilst non-smoking patients whose sole risk factor was HPV exhibited a 100% survival rate (p = 0.0029). Conclusion: This study confirms the significant temporal increase in HPV+ OPC, which confers a superior prognosis and higher complete response rates (83%) compared to smoking-associated disease. While HPV+ status yields a better overall outcome, tobacco use acts as a strong adverse factor, lowering the 30-month survival rate from 100% in single-risk factor HPV+ cases to 61%. Consequently, prevention and control strategies must prioritize HPV vaccination and tobacco cessation programmes to mitigate disease burden and optimize patient outcomes. References: Ndon S, Singh A, Ha PK, Aswani J, Chan JY, Xu MJ. Human Papillomavirus-Associated Oropharyngeal Cancer: Global Epidemiology and Public Policy Implications. Cancers (Basel). 2023 Aug 13;15(16):4080.Zumsteg ZS, Luu M, Rosenberg PS, Elrod JK, Bray F, Vaccarella S, Gay C, Lu DJ, Chen MM, Chaturvedi AK, Goodman MT. Global epidemiologic patterns of oropharyngeal cancer incidence trends. J Natl Cancer Inst. 2023 Dec 6;115(12):1544-1554. Keywords: Oropharyngeal cancer, epidemiology, HPV, tobacco.
Digital Poster 604
Toward Predictive Tools for Radiotherapy in Older Head and Neck Cancer Patients: Insights from Comprehensive Geriatric Assessment Colin Faulkner 1,2 , Gabriela Hernández Favela 3 , Shabbir M.H. Alibhai 3,4 , Nauman Malik 1,2 , Aruz Mesci 1,2
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