S578
Clinical – Head & neck
ESTRO 2026
https://doi.org/10.1073/pnas.2216399120 Keywords: nasopharyngeal, motor dexterity, precentral gyrus
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Prospective evaluation of xerostomia trajectory and long-term recovery after chemoradiotherapy for nasopharyngeal carcinoma in an LMIC Setting Nejla Fourati, Yosra Kochlef, Malek Dabbous, Wafa Mnejja, Zied Fessi, Wicem Siala, Jamel Daoud Radiotherapy Department Habib Bourguiba Hospital, Faculty of Medicine University of Sfax, Sfax, Tunisia Purpose/Objective: Xerostomia is one of the most disabling late side effects after nasopharyngeal carcinoma (NPC) treatment. Prospective long-term evaluations remain scarce, particularly in low- and middle-income countries (LMICs). This study assessed the evolution and persistence of patient-reported dry mouth symptoms using the EORTC/QLQ-C30 and QLQ-HN35 questionnaires. Material/Methods: An initial cohort of 45 NPC patients was prospectively followed. After a median follow-up of 83 months [68– 93], 21 patients who remained in complete remission were included in this long-term quality-of-life (QoL) analysis.The median age was 45 years [23–68], with a sex ratio of 2.5.All patients received intensity- modulated radiotherapy (IMRT) with concurrent chemotherapy, and 95% also underwent neoadjuvant chemotherapy. According to the 8th TNM edition, 47.6% had stage IVA disease.QoL was evaluated using the EORTC/QLQ-C30 and EORTC/QLQ-HN35 questionnaires (Arabic validated versions) at baseline (B), week3 (W3), week6 (W6), 1–6months (M1–M6), and long-term follow-up (L).Scores were linearly transformed to a 0–100 scale (higher scores = worse).As data distributions were non-normal, Wilcoxon tests were used for main contrasts (B–W3, B– W6, B–L, W6–L, M6–L), and a Friedman test evaluated overall time effects.For clinical interpretation, patients were categorized as improved, stable, or worsened between B, W6, M6, and L. Results: The Friedman test confirmed a significant overall time effect (p = 0.018).The mean xerostomia score increased from 26.7 ± 40.2 at baseline (B) to 62.2 ± 41.5 at week 3 (W3, p = 0.011) and 73.3 ± 38.2 at week 6 (W6, p = 0.004 vs B), indicating peak acute side effects.A gradual improvement was observed thereafter, with partial recovery at 6 months (M6: 60.6 ± 38.9, p = 0.065 vs B).At long-term follow-up, xerostomia further improved to 38.1 ± 33.8, remaining significantly lower than at treatment completion
Conclusion: NPC survivors post-IMRT have significantly impaired hand motor dexterity compared with matched population norms. Higher radiation dose to the precentral gyri were associated with worse motor dexterity in corresponding hands. Higher cumulative cisplatin doses were associated with impairments in both hands. These findings highlight the need for personalized treatment strategies to minimize neurotoxicity, and long-term neurocognitive monitoring and rehabilitation programs for NPC survivors. References: 1. Mitrushina, M., Boone, K. B., Razani, J., & D'Elia, L. F. (2005). Handbook of normative data for neuropsychological assessment (2nd ed.). Oxford University Press.2. Strauss, E., Sherman, E. M. S., & Spreen, O. (2006). A compendium of neuropsychological tests: Administration, norms, and commentary (3rd ed.). Oxford University Press.3. Billot, B., Magdamo, C., Cheng, Y., Arnold, S. E., Das, S., & Iglesias, J. E. (2023). Robust machine learning
segmentation for large-scale analysis of heterogeneous clinical brain MRI datasets.
Proceedings of the National Academy of Sciences of the United States of America, 120(9), e2216399120.
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