S591
Clinical – Head & neck
ESTRO 2026
trapezius muscle), internal/external/common carotid artery, posterior cranial nerves, and skin. The intermediate-risk structure group consisted of the sternocleidomastoid muscle, levator scapulae muscle, digastric muscle, splenius capitis muscle, and internal jugular vein. Multivariable Cox models showed that advanced CLN ENE with involvement of high-risk structures (defined as high-risk CLN ENE; 102/160, 63.7%) was an independent adverse prognostic factor for OS, PFS, and DMFS(p ＜ 0.01). In contrast, advanced CLN ENE combined with nodal necrosis, maximum axial diameter (MAD) > 3 cm, or bilaterality had no independent prognostic significance. N1/N2 patients with high-risk CLN ENE had survival outcomes comparable to those with N3 disease(p ＞ 0.05), with an adjusted hazard ratio (AHR) > 1. N1/N2 patients with intermediate-risk CLN ENE (advanced CLN ENE excluding high-risk CLN ENE) had significantly better OS than N3 patients(p=0.027), while their PFS and DMFS were comparable to those of N3 patients with an AHR < 1.
status ≥ 1 (subdistribution hazard ratio [sHR]: 2.2, 95% CI, 0.82–5.6), an oral cavity primary (sHR:2.9, 95% CI, 1.4–6.0), and clinical stage ≥ IV (sHR: 3.9, 95% CI, 0.92– 16) were associated with higher IFR. A simple risk- count model (sum of these three factors) stratified 1- year IFR to 86% (3 factors), 55% (2 factors), 15% (1factor), and 13% (none). Conclusion: IFR is a common recurrence pattern among elderly HNC patients treated with dRT alone. The cumulative incidence of IFR seemed to be high in patients with PS ≥ 1, an oral cavity primary, or stage IV disease. Keywords: Elderly patients, Head and neck cancer Structure-Specific Involvement and Synergy with Other Nodal Features in Advanced Extranodal Extension of Nasopharyngeal Carcinoma: A Dual- Center Study junyi liu, bolin lu, tong bu, tong jin, Lirong Wu, xia he Department of Radiation Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China Purpose/Objective: Extranodal extension (ENE) in cervical lymph nodes(CLN) has been incorporated into the N3 Digital Poster 2201 category for nasopharyngeal carcinoma (NPC)[1]. The aim of this study was to further explore the prognostic value of advanced CLN ENE involving different structures and whether it may exert synergistic effects with other nodal features. Material/Methods: A total of 1,174 non-metastatic NPC patients at two centers between 2011 and 2021 were enrolled. Pretreatment MRI was systematically reviewed. For advanced CLN ENE, all involved structures, as well as the corresponding nodal size, presence of necrosis, and bilaterality, were documented. Hazard ratios (HR) and random survival forests were used to identify the high-risk structure group. Kaplan–Meier methods and multivariable Cox models adjusted for confounding factors were applied to analyze overall survival (OS), progression-free survival (PFS), locoregional relapse- free survival (LRRFS), and distant metastasis-free survival (DMFS). Results: CLN metastasis was present in 972 of 1,174 patients (82.8%), among whom 160 (16.5%) had advanced CLN ENE. The high-risk structure group included the hyoid muscle, scalene muscle, longissimus capitis muscle, longissimus cervicis muscle, interval muscles (obliquus capitis inferior muscle, semispinalis capitis muscle, longus colli muscle, medial pterygoid muscle,
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