S628
Clinical – Head & neck
ESTRO 2026
who underwent chemoradiotherapy and had imaging available on hospital picture archival and communication system (PACS) at presentation and failure were considered suitable for the present analysis. Data was collected from electronic medical records, including demographic details, treatment specifics, HPV status, lymph node characteristics and treatment details. Imaging data was reviewed for both presentation and recurrence. Statistical analyses, including descriptive statistics and Chi-Square tests, were performed using SPSS version 24.0 to evaluate categorical data and clinical outcomes. Results: Of the 630 patients treated during the study period, 275 patients had the imaging available on PACS at presentation and at failure. At presentation imaging done was CT scan in 83 (30.2%) patients, 46 (16.7%) had MRI, and 146 (53.1%) had PET CT. Nodal involvement was observed in 227(82.5%) of patients at presentation with level II being the most common level in 215 (78.2%) patients. Of the 227 patients 183 (80.6%) had nodal size less than 30 mm and 67 (29.5%) had extranodal extension (ENE) present. Incidence of contralateral level II was 84 (30.5%).Incidence of contralateral level III was 20 (7.3%), level IVa was 12 (4.4%) and IVb was 8 (2.9%). One hundred and six (38.5%) patients developed nodal failure. Out of 106, 104 nodes measured less than 30 mm (98.1%), 2 were between 30 and 60 mm (1.9%), and none exceeded 60 mm (0%). Ipsilateral level II failure was observed in 87 (31.6%) patients, ipsilateral III in 23 (8.4%), IVA in 9 (3.3%). Contralateral level II was observed in 32 (11.6%), level III in 4 (1.5%) and level IVa in 2 (0.7%). Ipsilateral level II involvement at presentation showed statistically significant correlation with the presence of ipsilateral levels III and IV, as well as contralateral level II. Conclusion: At presentation, ipsilateral level II followed by ipsilateral level III was the most commonly affected nodal site. Other levels, including ipsilateral IVa, V, and contralateral III, IV, and V, show much lower involvement rates. For persistent or recurrent disease, ipsilateral level II continues to be the most frequently involved node, followed by contralateral level II and ipsilateral level III. Contralateral III and IV show minimal recurrence, suggesting they can be excluded from radiotherapy. References: 1.Abdel-Halim CN, O’Byrne TJ, Graves JP, Akpala CO, Moore EJ, Price DL, et al. Patterns and distribution of regional nodal involvement and recurrence in a surgically treated oropharyngeal squamous cell carcinoma cohort at a tertiary center. Oral Oncol [Internet]. 2023;146(May):106569. 2. Bataini JP, Bernier J, Brugere J, Jaulerry C, Picco C, Brunin F. Natural history of neck disease in patients with squamous cell
in the age- and sex-adjusted German reference population. Eighty-one patients (51.3%) exhibited clinically relevant fatigue ( ≥ 39 points). Fatigue severity was associated with lower QoL (Pearson’s r=-0.388, p<0.01), higher psychological distress (r=0.451, p<0.01), anxiety (r=0.288, p<0.05), and depression (r=0.492, p<0.001). Age, sex, smoking, Charlson Comorbidity Index, tumor site, tumor stage, concurrent systemic therapy, treatment (definitive versus adjuvant radiotherapy), or time since radiotherapy were all not associated with fatigue, whereas patients with impaired baseline performance status reported higher fatigue levels (ECOG 1-2: 49.9 ± 31.0 vs ECOG 0: 40.2 ± 24.8, p<0.05). Neither radiation doses to cerebral OAR nor baseline SMI were risk factors for patient-reported fatigue, and voxel-based mapping did not reveal any associated subregions. Conclusion: Approximately half of head and neck cancer survivors reported clinically relevant fatigue after (chemo)radiotherapy, nearly twice the prevalence in the general population. Fatigue was unrelated to cerebral OAR dose, and voxel-based mapping revealed no associated cerebral subregions. Awareness of fatigue as a frequent survivorship issue in head and neck cancer survivors is needed. Keywords: Patient-reported outcome, survivorship Pattern of nodal presentation and nodal failure in patients of carcinoma oropharynx treated with definitive chemoradiotherapy Ashwini Budrukkar 1 , Shabnam Banu 1 , Sheetal Kashid 1 , Monali Swain 1 , Sarbani Ghosh Laskar 1 , Amit Janu 2 , Venkatesh Rangarajan 3 , Shwetabh Sinha 1 , Anuj Kumar 1 , Samarpita Mohanty 1 , Kumar Prabhash 4 , Vanita Norohna 4 , Vijay Patil 4 , Jai Prakash Agarwal 1 1 Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Insitute, Mumbai, India. 2 Department of Radiology, Tata Memorial Hospital, Homi Bhabha National Insitute, Mumbai, India. 3 Department of Nuclear Medicine, Tata Memorial Hospital, Homi Bhabha National Insitute, Mumbai, India. 4 Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Insitute, Mumbai, India Purpose/Objective: The aim of this study was to evaluate the pattern of nodal presentation and persistence/failure in oropharyngeal cancer treated with definitive Digital Poster 3626
chemoradiotherapy. Material/Methods:
Patients diagnosed with oropharyngeal cancer at a single institution from January 2013 to December 2017
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