S573
Clinical – Head & neck
ESTRO 2026
Results: One hundred patients from a single centre (55 CRT vs 45 PORT) were included. Baseline characteristics were similar between groups, although bilateral neck radiotherapy treatment (p<0.001) and HPV detectability (p<0.001) were more frequent in the RT group.All PORT patients received elective neck physiotherapy rehabilitation pre-radiotherapy, whereas none of the CRT patients did. There was a significantly higher and earlier onset of neck fibrosis in patients undergoing PORT (64%) vs CRT (20%) (figure 1). In multivariable Cox regression, treatment type was the only independent predictor of neck fibrosis: PORT vs CRT HR 7.63 (95% CI 2.81–20.71, p<0.001; figure 2). Stage, primary site, smoking, alcohol use, ECOG-PS, CCI and use of medications previously linked to fibrotic risk were not significantly associated with neck fibrosis development.
Conclusion: Distant metastases are the main cause of treatment failure, followed by regional recurrence of which >1/2 in the high dose region. Emergence of a primary tumor was observed in one patient outside the electively treated mucosa. Keywords: Recurrence, elective neck
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Neck dysfunction is worse after post-operative versus radical radiotherapy in head and neck cancer: results of a retrospective cohort study Patrick Corbett 1 , Rachel Wijayrathna 2,3 , Sabina Khan 4 , Boris Tocco 5,3 , Gareth D Jones 2,5 , Imran Petkar 3 , Delali Adjogatse 3 , Teresa Guerrero-Urbano 3 , Anthony Kong 3 , Mary Lei 3 , Nicola Peat 2 , Ruheena Mendes 4 , Miguel Reis Ferreira 3,6 1 Ageing and Health, Guy's and St Thomas' NHS Trust, London, United Kingdom. 2 Physiotherapy, Guy's and St Thomas' NHS Trust, London, United Kingdom. 3 Department of Oncology, Guy's and St Thomas' NHS Trust, London, United Kingdom. 4 Department of Oncology, University College Hospital, London, United Kingdom. 5 Centre for Human & Applied Physiolocal Sciences (CHAPS), Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom. 6 Centre for Host-Microbiome Interaction, King's College London, London, United Kingdom Purpose/Objective: Neck fibrosis is a clinically significant and often progressive side-effect of radiotherapy for head and neck cancer (HNC) that can result in functional impairments and reduced quality of life (QOL). Despite its prevalence, onset and clinical predictors remain poorly defined and comparative data between treatment modalities are limited.AimsWe aimed to characterise the incidence and timing of neck fibrosis after chemoradiotherapy (CRT), compare risk between primary CRT and post-operative radiotherapy (PORT) and identify independent clinical predictors. Material/Methods: This retrospective cohort study included patients with HNC who underwent either CRT or PORT. Neck fibrosis was evaluated according to the CTCAE v5.0 pre- treatment, during treatment, and at 3, 6 and 12 months after treatment. Kaplan–Meier curves stratified by treatment type were compared with the log-rank test. Adjusted hazard ratios (HR) and 95% confidence intervals (CI) were estimated using multivariable Cox regression that included treatment type, disease stage, primary site, smoking, alcohol use, ECOG performance status (ECOG-PS), Charlson Comorbidity Index (CCI) and medications associated with antifibrotic effects.
Conclusion: PORT was associated with a higher hazard of neck fibrosis than CRT. Our results suggest that these differences should integrate the informed consent process, particularly where patients are offered a choice of surgery or RT as primary therapy. They also suggest that trials comparing these modalities in HNC should include neck function endpoints. The 20% incidence of neck fibrosis in patients who undergo CRT is clinically meaningful and warrants further exploration. Future prospective studies should evaluate the impact of neck fibrosis on function and QOL and explore how interventions such as targeted counselling and early physiotherapy rehabilitation can mitigate against neck fibrosis and optimise recovery.
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