S603
Clinical – Head & neck
ESTRO 2026
Purpose/Objective: According to GLOBOCAN 2022, India contributes approximately 57.5% of global head and neck cancer cases, with the highest burden in the north-eastern region. Despite the proven advantages of Dysphagia aspiration related structures (DARS)-sparing Intensity modulated radiotherapy (IMRT), resource limitations, geographical constraints, and manpower shortages often necessitate the continued use of conventional cobalt teletherapy in this region. Data on the functional outcomes, especially swallowing function, following cobalt-based radiotherapy remain limited. In this study we have objectively evaluated the swallowing function using the Penetration-Aspiration Scale (PAS) and Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in patients receiving conventional radiotherapy in cobalt teletherapy for head and neck cancers. Material/Methods: A prospective observational cohort study was conducted at the Department of Radiation Oncology, Dr. B. Borooah Cancer Institute, Guwahati. Adult patients (18–65 years) with histologically confirmed oropharyngeal, hypopharyngeal, or laryngeal squamous cell carcinoma planned for definitive radiotherapy or chemoradiotherapy using conventional techniques were enrolled. Exclusion criteria included prior head-and-neck radiation, metastatic disease, neoadjuvant chemotherapy, or ECOG ≥ 3.Patients received 70 Gy in 2-Gy fractions over 6.5–7 weeks with concurrent cisplatin (40 mg/m ² weekly) or carboplatin (AUC 2) where indicated. FEES and PAS assessments were performed at four time points — pre-treatment, immediate post-treatment, 6 weeks, and 3 months post-radiotherapy. Statistical analysis was performed using SPSS v29.0, applying Chi-square/Fisher’s exact tests with a significance threshold of p < 0.05. Results:
patients.Baseline FEES showed minimal aspiration, but PAS scores worsened significantly post-treatment and at subsequent follow-ups, indicating progressive swallowing dysfunction. Feeding-tube dependence rose from 4% pre-treatment to 37% during therapy. Higher PAS scores correlated significantly with advanced T-stage, hypopharyngeal subsite, baseline impairment, and vocal-cord immobility, as well as with vallecular/pyriform sinus residue (p < 0.05). Conclusion: Conventional cobalt teletherapy leads to a significant decline in swallowing safety and efficiency. Transitioning toward IMRT/Volumetric modulated Arc Therapy (VMAT) with DARS-sparing protocols can substantially mitigate long-term dysphagia. Baseline FEES and PAS have predictive potential for identifying high-risk patients. A structured surveillance program incorporating serial FEES (pre-, mid-, end-, and post- radiotherapy) is recommended for early detection and intervention of treatment-induced dysphagia. References: 1. Nguyen NP, Frank C, Moltz CC, Vos P, Smith HJ, Bhamidipati PV, et al. Aspiration rate following chemoradiation for head and neck cancer: an underreported occurrence. Radiother Oncol J Eur Soc Ther Radiol Oncol. 2006 Sep;80(3):302–6.2. Langerman A, Maccracken E, Kasza K, Haraf DJ, Vokes EE, Stenson KM. Aspiration in chemoradiated patients with head and neck cancer. Arch Otolaryngol Head Neck Surg. 2007 Dec;133(12):1289–95.3. Agarwal J, Palwe V, Dutta D, Gupta T, Laskar SG, Budrukkar A, et al. Objective Assessment of Swallowing Function After Definitive Concurrent (Chemo)radiotherapy in Patients with Head and Neck Cancer. Dysphagia. 2011 Dec 1;26(4):399–406. Keywords: PAS SCORE, SWALLOWING FUNCTION, RADIOTHERAPY Validation and development of Locally advanced nasopharyngeal carcinoma in non-high-incidence regions based on AJCC/UICC TNM-9: A multicenter study Tong Bu, Tong Jin, Jun-yi Liu, Bo-lin Lu, Ting Qiu, Li- Rong Wu, Xia He Department of Radiation Oncology, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, Nanjing, China Purpose/Objective: To evaluate the prognostic performance of the 9th AJCC/UICC TNM staging system (TNM-9)1 in the patients of locally advanced nasopharyngeal (LA-NPC) and to develop refined intra-stage subgroups to support individualized treatment. Digital Poster 2798
A total of 68 patients were analysed, predominantly male (84%), with the 51–60-year age group forming the largest subset (49%). Hypopharyngeal (41%) and oropharyngeal (35%) primaries predominated, with advanced T-stage (T3–T4a: 71%) disease. Concurrent chemoradiotherapy was administered to 93% of
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