S579
Clinical – Head & neck
ESTRO 2026
weekly. Salivary flow measurements, LENT-SOMA assessment of xerostomia and quality of life evaluation were performed before and 6, 12 and 24 months after radiotherapy. Primary endpoint was 1- year radiation-induced LENT SOMA subjective xerostomia grade 2+: a total of 44 patients (including a drop-out rate of 10%) were required to demonstrate a reduction from 38% in historical IMRT-reports1 to 20% in the trial group in an one-sided test with a power of 80% and type I error of 5%.
(W6, p = 0.020), yet still above baseline levels.Compared with W6, 47.6% of patients experienced an improvement, while 4.8% worsened.Compared with B, about one-third (28.6%) reported persistent worsening, although the difference did not reach statistical significance (p = 0.138). Conclusion: Xerostomia follows a dynamic trajectory with a sharp acute peak and partial but incomplete long-term recovery.Despite resource limitations, IMRT in Tunisia achieved comparable long-term QoL outcomes to high-income settings.These results underscore the potential of resource-adapted, high-quality radiotherapy and the importance of structured survivorship and supportive care programs to reduce late toxicity in LMIC contexts. Keywords: xerostomia, nasopharyngeal carcinoma MRI-guided adaptive radiotherapy reduces xerostomia in head and neck squamous cell carcinoma patients: primary endpoint reporting of the MARTHA trial Esmée L Looman 1 , Stephanie Tanadini-Lang 1 , Lotte Wilke 1 , Paul Schumann 2 , Daniel Farhoumand 2 , Simon A Mueller 3 , Gregoire B Morand 3 , Debra Lauer 1 , Nicolaus Andratschke 1 , Matthias Guckenberger 1 , Panagiotis Balermpas 1 1 Department of Radiation Oncology, Zurich University Hospital, University of Zurich, Zurich, Switzerland. 2 Department of maxillofacial surgery, Zurich University Hospital, University of Zurich, Zurich, Switzerland. 3 Department of Otorhinolaryngology, Zurich University Hospital, University of Zurich, Zurich, Switzerland Purpose/Objective: Radiotherapy-induced xerostomia remains a quality- of-life compromising side effect for patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN), even in the era of highly conformal intensity modulated radiotherapy (IMRT). This prospective clinical trial aimed to investigate the value of weekly MRI-guided adaptive radiotherapy (MRIgART) to reduce xerostomia. Material/Methods: Mini-Oral 1770 In this single-center, prospective, open label, single- arm, phase II trial (NCT03972072), patients with histologically confirmed SCCHN requiring bilateral neck irradiation were recruited. A 3 mm margin was used to form PTV. Treatment was performed using the MRIdian system (ViewRay Inc.). Daily online 0.35 T imaging was performed for patient positioning, position correction and GTV-gating. A full offline contour and plan adaptation was performed, once
Results: 49 patients were recruited between 2019 and 2024, including 5 dropouts (patient and treatment characteristics in table 1). All results were assessed in the per-protocol cohort: 44 patients (11 female, median age 61) completed per-protocol treatment with minimum 5 adaptations and minimum 60% of daily MR-guided radiotherapy. The median dose applied was 70 Gy (range: 68-70 Gy) in 35 fractions. Median follow up at the point of this analysis was 24 months with a 2-year overall survival of 88% and 2- year locoregional control rate of 80%. At 12 months the proportion of patients with grade 2+ xerostomia was 14%, confirming the hypothesis of this trial. The mean stimulated salivary flow at baseline was 1687 mg/min (range: 400-5484) and 1090 mg/min (range: 400-2380) after one year, i.e. 65% of the baseline mean absolute salivary flow could be retained2. No unexpected adverse events were observed with non- hematological grade III events occurring in 23%.
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