S612
Clinical – Head & neck
ESTRO 2026
3 Department of Otorhinolaryngology-Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan Purpose/Objective: To investigate the feasibility of a treatment protocol with induction chemotherapy (IndCT) followed by concurrent chemoradiotherapy (CCRT) focusing on the reduction of radiation dose in nasopharyngeal carcinoma (NPC) patients. Material/Methods: The inclusion criteria were previously untreated, biopsy-proven NPC patients. IndCT consists
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Patterns of adjuvant treatment and survival in non-metastatic stage III/IV oral cavity squamous cell carcinoma patients treated radically by age group Wahyu Wulaningsih 1 , Thomas Young 1 , Khrishanthne Sambasivan 1 , Selvam Thavaraj 2,3 , Ann Sandison 4 , Gillian Hall 4 , Lisette Collins 4 , Paris Tamiolakis 4 , Alastair Fry 2 , Mustansir Alibhai 2 , Ricard Simo 2 , Asit Arora 2 , Aleix Rovira 2 , Rafal Niziol 2 , Richard Oakley 2 , Jean-Pierre Jeannon 2 , Miguel Reis Ferreira 1 , Anthony Kong 1 , Delali Adjogatse 1 , Imran Petkar 1 , Mary Lei 1 , Teresa Guerrero- Urbano 1 1 Head and Neck Clinical Oncology Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. 2 Head and Neck Surgery Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom. 3 Department of Oral and Maxillofacial Clinical Sciences, University of Malaya, Kuala Lumpur, Malaysia. 4 Head and Neck Pathology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom Purpose/Objective: To evaluate the patterns of adjuvant treatment and survival outcomes in non-metastatic stage III/IV oral cavity squamous cell carcinoma (OCSCC) treated with curative intent across different age groups. Material/Methods: We retrospectively reviewed the records of patients referred to the oncology service with non-metastatic stage III/IV OCSCC between January 2010 and September 20231. Clinical information including AJCC TNM 7 staging, comorbidities2, treatment modality and intent, recurrences and cause of death were derived from electronic patient records. Kaplan-Meier curves with log-rank statistics and Cox regression were used to assess overall (OS) and progression-free survival (PFS) from the date of surgery to death, locoregional or distant recurrences, or last follow-up date. Cumulative incidence curves were used to evaluate cancer-specific deaths in presence of competing causes3. Results: A total of 517 patients with non-metastatic stage III/IV OCSCC were reviewed by the Oncology team for consideration of treatment. Of these, 392 were deemed suitable by the multidisciplinary team to receive radical treatment, of whom 67 did not proceed to adjuvant therapy (59 due to lack of fitness/delayed recovery/patient choice, 8 had recurrence after surgery) and 13 were treated elsewhere. A total of 286 received adjuvant therapy (194 radiotherapy, 92 chemoradiotherapy) with intensity-modulated radiation therapy (IMRT), whereas 26 who were treated with non-IMRT technique were excluded. Of
of weekly C-D-FL-EM (cisplatin, docetaxel, 5- fluorouracil + leucovorin, and epirubicin +
methotrexate) x 12 weeks. One week after IndCT, we started IMRT with dose reduction, 59.4 Gy/33 fractions in good responders (plasma EBV DNA dropped to undetectable and major metabolic response in PET/CT scan). The remaining patients received 66-70 Gy. Concurrent chemotherapy of 4-6 weekly cisplatin 50 mg/m2 was delivered. Results: Baseline characteristics of 110 newly diagnosed patients who had finished the treatment are as followings: median age=48 (range 29-86); male/female=88/22; performance status ECOG 0/1/2=24/84/2; overall stage I/II/III/IV=9/27/36/38. We obtained an overall response rate of 96.4% (CR 69.1% + PR 27.3%) after IndCT and 99.1% CR after CCRT. 75 of 110 (68.2%) patients received reduced-dose RT 59.4 Gy. The major toxicities of IndCT are leucopenia (30.0% grade 3/4) and neutropenia (57.3% grade 3/4). Other grade 3/4 toxicities included anemia (3.6%), diarrhea (3.6%), nausea (0.9%), vomiting (2.7%), and fatigue (2.7%). The major adverse effects during CCRT phase were also hematologic toxicities with grade 3/4 rates of 41.8% leucopenia, 40.9% neutropenia, 19.1% thrombocytopenia, and 10.0% anemia. After a median follow-up time of 31 months (range 15-51), we observe 12 treatment failures (4 local, 4 neck, and 4 distant). The 2-year locoregional failure-free, distant failure- free, progression-free, and overall survival rates were 93.6%, 97.3%, 90.9%, and 98.1%, respectively for all 110 patients. Only one of 75 patients who received reduced-dose RT 59.4 Gy experienced local
recurrence. Conclusion:
Our protocol of IndCT followed by CCRT with reduced RT dose to 59.4 Gy are feasible and can maintain excellent local control in selected patients. Keywords: dose de-intensification radiotherapy
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