S552
Clinical – Head & neck
ESTRO 2026
validate these findings and define predictive cut-off values for clinical use. References: 1.Kawashita Y et al Association of neutrophil-to- lymphocyte ratio with severe radiation-induced mucositis in pharyngeal or laryngeal cancer patients: a retrospective study. BMC Cancer. 2021 Sep 28;21(1):1064. doi: 10.1186/s12885-021-08793-6. PMID: 34583669; PMCID: PMC8480102.2.Minhas S et al Assessment and prevalence of concomitant chemo- radiotherapy-induced oral mucositis in patients with oral squamous cell carcinoma. Turk J Med Sci. 2021 Apr 30;51(2):675-684. doi: 10.3906/sag-2007- 1313.Chen AY et al. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory. Arch Otolaryngol Head Neck Surg. 2001 Jul;127(7):870-6 Keywords: head and neck cancer, neutrophil- lymphocyte ratio Digital Poster 920 Quantitative evaluation of late radiation-induced skin toxicity in head and neck cancer using Cutometer elasticity: a prospective study Mitsutoshi Ooishi 1 , Takeshi Imaizumi 1 , Keiichi Ohira 1 , Yoshio Yamashita 2 , Yoichiro Sugiyama 3 , Osamu Togao 1 1 Department of Radiology, Faculty of Medicine, Saga University, Saga, Japan. 2 Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Saga University, Saga, Japan. 3 Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Saga University, Saga, Japan Purpose/Objective: To objectively and quantitatively evaluate late radiation-induced skin toxicity after curative-intent radiotherapy for head and neck cancer using a Cutometer-based skin elasticity measurement system. Material/Methods: This prospective observational study included 18 patients with squamous cell carcinoma of the head and neck treated with curative-intent radiotherapy from January 2023 to October 2024. The median age was 69.5 years (range, 49–81), and the male/female ratio was 17/1. More than half had Stage III or IV disease according to the UICC 8th edition. Primary sites included the hypopharynx (n=7, the most common), larynx, oropharynx, and oral cavity. Seventeen patients received definitive radiotherapy and one received salvage radiotherapy. Concurrent chemotherapy was given in 17 patients, most commonly high-dose cisplatin (n=8). All patients underwent IMRT encompassing gross disease and elective mucosal and cervical nodal regions, with a
CTCAE and OMAS, while swallowing-related quality of life was assessed using MDADI at corresponding timepoints. Correlations between NLR and each toxicity scale were calculated using the Spearman rank correlation at T3. Statistical significance was defined as
p < 0.05. Results:
At the time of peak toxicity (T3), a total of 19 patients had complete paired data. NLR showed a weak, non- significant positive correlation with mucositis scores: CTCAE vs NLR: ρ = 0.17, p = 0.51 (N = 18); OMAS vs NLR: ρ = 0.22, p = 0.36 (N = 19). Conversely, NLR was inversely correlated with functional swallowing scores: MDADI vs NLR: ρ = –0.39, p = 0.09 (N = 19), showing a trend toward statistical significance. Patients with higher systemic inflammation (higher NLR) tended to report poorer MDADI scores, suggesting a link between systemic and mucosal inflammatory burden. Figures 1–2 illustrate the relationships between NLR and toxicity endpoints at T3.
Conclusion: At the peak of mucosal toxicity, higher NLR values were weakly associated with worse clinical and functional outcomes. Although not statistically significant in this sample, the direction of association supports the hypothesis that systemic inflammatory status mirrors local radiation-induced mucosal injury. NLR, an inexpensive and widely available marker, may contribute to early identification of patients at higher risk for severe mucositis and functional decline. Larger, prospective studies with integrated inflammatory and clinical biomarkers are warranted to
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