S597
Clinical – Head & neck
ESTRO 2026
dissection if 1ry site was well lateralized, and bilateral dissection if not or if crossing midline. Operative bed PORT 60 Gy/ 30 fractions was given to all patients. Nodal irradiation was added, in case of node positive disease, to the involved hemi-neck; 60 Gy to high risk and 54 Gy lower risk nodal levels (over 30 fractions – SIB). Elective nodal irradiation was omitted to the pathologically (pN0) or PET-CT node negative hemi or bilateral neck. If patients with a 1ry disease crossing midline had one sided positive nodal disease, a de- escalated 39.9 Gy dose was given to high risk nodal levels of pN0 hemi neck. Results: Eighty-three patients were included. The mean age was 55 ±12 years, 43 (51.8%) were males, and 30 (36.1%) were smokers. Sites included tongue (n =56), other oral cavity subsites (n=12), and larynx (n=15). According to the American Joint Committee on Cancer Staging Manual (8th edition) 70 patients (84%) had Stage III/IV disease. Fifty patients had bilateral neck radiotherapy (RT) omission, 30 had one sided neck RT omission, and 4 received 39.9 Gy to the pN0 side. Twelve patients (14.5%) received concurrent Cisplatin. At a median follow up of 24 months, 4 patients (4.8%) experienced solitary failure in the un-irradiated neck. Two of the failures occurred in an initially pN0 neck, and two in a PETCT negative un-dissected contralateral neck. A 5th patient experienced synchronous operative bed recurrence and un-irradiated neck failure. The two-year rates of locoregional recurrence free survival, disease free survival, and overall survival were 73%, 64%, and 70%, respectively. Conclusion: In this cohort, omission/De-escalation of RT to the negative neck in H&N SCC patients receiving PORT does not compromise control rates in the un- irradiated neck. References: 1. The Royal College of Radiologists. Head and neck cancer: RCR consensus statements. London (UK): The Royal College of Radiologists; 2022 Feb.2. Koyfman SA, Ismaila N, Crook D, D’Cruz A, Rodriguez CP, Sher DJ, et al. Management of the neck in squamous cell carcinoma of the oral cavity and oropharynx: ASCO clinical practice guideline. J Clin Oncol. 2019;37(20):1753–1774. doi:10.1200/JCO.18.01921.3. Amin MB, Edge SB, Greene FL, Byrd DR, Compton CC, Gershenwald JE, et al., editors. AJCC cancer staging manual. 8th ed. New York: Springer; 2017. Keywords: Postoperative Radiotherapy, Nodal Omission
Conclusion: Adjuvant radiotherapy after surgery produced survival outcomes comparable with contemporary reports. Among patients managed without contralateral neck dissection and contralateral RT, contralateral neck failure was uncommon (8%), and isolated contralateral relapse was rare (5%). Taken together, these data support selective omission of contralateral neck irradiation in carefully staged, laterally confined OCSCC. Keywords: Head & neck cancer, Radiotherapy, Relapse Mini-Oral 2482 Postoperative RT De-Escalation/Omission of Negative Nodal Regions in Head & Neck Squamous Cell Carcinoma: A prospective phase 2 study NCT05650034 Sara A Elsharkawy 1,2 , Ashraf H Hassouna 1 , Tarek H Shouman 1 , Amr M Amin 1 , May G Ashour 1 1 Radiation Oncology, National Cancer Institute, Cairo, Egypt. 2 Clinical oncology, imperial college healthcare nhs trust, London, United Kingdom Purpose/Objective: Postoperative radiotherapy (PORT) is indicated in a large fraction of head and neck (H&N) cancers. Regardless of indication, PORT includes operative bed and nodal irradiation per guidelines.This is associated with significant acute and long-term toxicities, primarily due to the large treatment volume and high prescription dose. In this study nodal irradiation to the node negative neck pathologically or by PET-CT was
omitted/de-escalated. Material/Methods:
This is a prospective non-randomized phase II trial of H&N squamous cell carcinoma (SCC) patients who presented from March 2021 to June 2024. The 1ry end point is regional failure in the omitted/de-escalated neck nodal region. All patients underwent 1ry site surgical resection. Patients had ipsilateral neck node
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