S582
Clinical – Head & neck
ESTRO 2026
vs 52 days, p = 0.04). Planned weekly cisplatin was completed in 70% of rural versus 86% of urban patients. Grade ≥ 3 mucositis occurred more often in rural patients (31% vs 18%, p = 0.05). At a median follow-up of 32 months, 2-year locoregional control, progression free survival, and overall survival were 64%, 58%, and 63%, respectively; all were significantly lower for rural compared with urban cohorts (p = 0.03). Median net OOP expenditure was INR 42,000 [IQR 29,000 - 61,000], higher among rural patients (INR 47,000 vs 29,000, p < 0.001). Catastrophic expenditure occurred in 48% rural vs 17% urban households. On multivariate analysis, rural residence (HR 1.72 [1.08- 2.74]) and OTT > 50 days (HR 1.58 [1.02-2.44]) independently predicted poorer progression free survival. Conclusion: Substantial disparities exist between urban and rural patients receiving chemoradiation for p16-negative OPSCC. Rural residence was associated with more treatment delays, less compliance with concurrent chemotherapy, higher toxicity, inferior disease control, and a markedly greater financial burden. Streamlined referral pathways, reduction in RT start delays, and targeted financial support could help bridge these inequities and improve outcomes in resource- constrained regions. Keywords: Oropharyngeal ca, Disparities, OOP expenditure Proffered Paper 2030 Evolving radiotherapy techniques and their impact on organ-of-interest doses and side effects in oropharyngeal cancer Hendrike Neh, Lisanne V. van Dijk, Lisa G.L.J. van den Bosch, Hans Paul van der Laan, Roel J.H.M. Steenbakkers, Johanna G.M. van den Hoek, Hans H.G. Verbeek, Tineke W.H. van Zon-Meijer, Edwin Oldehinkel, Makbule Atasoyu, Arjen van der Schaaf, Johannes A. Langendijk Radiotherapy, University medical center Groningen, Groningen, Netherlands Purpose/Objective: Radiotherapy for head and neck cancer has markedly evolved, improving tumour targeting while sparing normal tissue. Techniques progressed from 3D-CRT to IMRT, VMAT, and proton therapy. Prioritization of organs of interest (OOI) shifted from parotid glands to swallowing muscles and now multi-organ-sparing strategies (including submandibular glands and oral cavity). The cumulative impact on OOI dose and side effects remains to be evaluated. This study investigates how radiotherapy evolution over 15 years has affected OOI dose and two common side effects
Phys. 2014;90(1):S788. [3]Todorovic V, Prevc A, et al. Pulsed low dose-rate irradiation response in isogenic HNSCC cell lines with different radiosensitivity. Radiol Oncol. 2020;54(2):168-179.[4]Huang R, Li Z, Yang F, et al. Efficacy and safety of PLDR-IMRT for the re- irradiation of recurrent NPC: A prospective, single-arm, multicenter trial. Cancer Sci. 2023 Jun;114(6):2534- 2543. Keywords: PLDR ， Nasopharyngeal carcinoma(NPC) ， Re-irradiation Disparities in access, outcomes, and costs in oropharyngeal cancer radiotherapy: a single institution experience Janmenjoy Mondal, Bidyut Mandal, Debottam Barman, Subrata Chatterjee, Sattwik Basu, Lirisha ., Jayabrata Biswas, Ipsita Chakraborty Radiation Oncology, Medical College & Hospital Kolkata, Kolkata, India Purpose/Objective: Geographic and socioeconomic barriers can influence timely access, treatment quality, and affordability of radiotherapy (RT) for oropharyngeal squamous cell Digital Poster 2027 carcinoma (OPSCC) in resource-limited settings. Evidence on how these disparities translate into survival outcomes remains scarce, particularly for HPV negative disease that continues to dominate in India. This study aimed to evaluate differences in access, treatment delivery, clinical outcomes, and out-of- pocket (OOP) expenditure between urban and rural patients treated with definitive concurrent chemoradiation for OPSCC at a tertiary care centre in Eastern India. Material/Methods: A prospective institutional database was reviewed for patients with p16-negative, non-metastatic OPSCC treated with conformal curative-intent concurrent chemoradiation between January 2019 and December 2023. Demographic, clinical, and socioeconomic details were collected. RT technique, dose, concurrent chemotherapy compliance, and timelines from diagnosis to RT start and overall treatment time (OTT) were documented. OOP expenses were recorded under direct medical and indirect cost components. Catastrophic expenditure was defined as net OOP ≥ 10% of annual household income. Survival outcomes were analysed using Kaplan-Meier estimates, with Cox regression for prognostic factors. Results: A total of 134 patients were included; the median age was 56 years, 85% were male, and 61% resided in rural areas. Rural patients experienced longer diagnosis-to- RT intervals (59 vs 47 days, p = 0.01), extended OTT (58
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