S542
Clinical – Head & neck
ESTRO 2026
Proffered Paper 609
Celecoxib versus oral Glutamine to prevent acute radiation mucositis in head and neck cancers – a double-blind randomised controlled trial Shyama Prem S 1 , Salman Haider 1 , Sivaraman G 2 , Ambedkar Yadala 1 , Ramkumar G 3 , Sandhiya Selvarajan 4 , N Sreekumaran Nair 5 , Anusuya R 5 , Harish M 1 , Ananth R 1 1 Radiation Oncology, JIPMER, Pondicherry, India. 2 ENT, JIPMER, Pondicherry, India. 3 Radiodiagnosis, JIPMER, Pondicherry, India. 4 Clinical Pharmacology, JIPMER, Pondicherry, India. 5 Biostatistics, JIPMER, Pondicherry, India Purpose/Objective: Radiation-induced oral mucositis (RIOM) is a common, dose-limiting toxicity in head and neck cancer patients undergoing curative radiotherapy, with or without chemotherapy. RIOM causes pain, dysphagia, and weight loss, leading to treatment interruptions and reduced local tumour control. While oral glutamine and topical agents offer limited benefit, systemic anti- inflammatory therapy may provide broader protection. Celecoxib, a selective COX-2 inhibitor, could reduce mucosal inflammation. This study compared the efficacy and safety of oral celecoxib versus glutamine in preventing acute RIOM. Material/Methods: This double-blind, double-dummy randomised controlled trial was conducted at a tertiary hospital in India between May 2024 and June 2025. A total of 119 patients with histologically confirmed squamous cell carcinoma of the head and neck were randomised 1:1 to receive either oral celecoxib 200 mg daily plus placebo powder (Arm A) or oral glutamine 20 g daily plus placebo tablet (Arm B) during volumetric modulated arc therapy (66–70 Gy). Both arms received standardised supportive oral care, including benzydamine mouthwash. Patients were evaluated weekly for mucositis severity (RTOG and CTCAE v5.0), pain (Numeric Rating Scale), opioid use, tube-feeding requirement, weight changes, and quality-of-life outcomes. Patients with GI bleeding, inflammatory bowel disease, severe hepatic, renal, or cardiovascular impairment, celecoxib allergy, or a history of thromboembolic events were excluded.The primary endpoint was the incidence of RTOG grade ≥ 3 oral mucositis, while secondary endpoints included grade ≥ 2 mucositis, time to onset, functional outcomes, and treatment-related toxicity.
Conclusion: In this foundational study, OACC geriatrician
recommendation to proceed with treatment or de- escalate is the only significant predictive factor for treatment interruptions. Common CGA tools show limited predictive value for radiotherapy treatment interruption, completion, late toxicity, and disease outcomes. These findings support development of predictive tools to optimize radiotherapy in older adults with HNC. The study's next phase will explore additional factors collected in the CGA and expand to other anatomical sites. The study's final phase will use these insights to generate and validate a predictive tool for use in older adults. Keywords: HN Cancer, Radiotherapy Interruption, Geriatrics
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