S650
Clinical – Head & neck
ESTRO 2026
Digital Poster Highlight 4117
Compliance to national guidelines for head and neck cancer patients with nodal involvement treated with curative radiotherapy and weekly cisplatin Emilie HK Overgaard 1 , Hanne Primdahl 2 , Kasper Toustrup 2 , Nicolai Andreassen 2 , Line MH Schack 2 , Jens Overgaard 1 , Jesper G Eriksen 1 1 Dept. Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark. 2 Dept. of Oncology, Aarhus University Hospital, Aarhus, Denmark Purpose/Objective: Weekly cisplatin concomitant to radiotherapy (cis-RT) is considered well tolerated in fit patients and is widely used as primary treatment for node-positive head and neck squamous cell carcinoma (HNSCC). The aim was to evaluate compliance to concomitant cis-RT according to national guidelines in a population-based series of HNSCC patients. Material/Methods: Consecutive patients with HNSCC (oral cavity, larynx and pharynx (nasopharynx excluded) between 2014- 2022 were prospectively registered in the local DAHANCA database covering a region of 1.4 million inhabitants.National DAHANCA guidelines recommend concomitant chemo-radiotherapy with cisplatin 40mg/m2; 66-68Gy/33-34Fx; 6 fx/week or 76Gy/56fx BID, 10fx/week and the hypoxic radiosensitizer, nimorazole to patients with node-positive HNSCC. Data were validated using patient files including biochemistry, pathology and imaging. Results: In total 1931 patients were registered in the period, and 741 patients were node-positive and received curative intended primary radiotherapy. Of those 504 (68%) received cis-RT (table 1) according to national guidelines (figure 1). The median age was 59 years at diagnosis (38-75 years); predominantly men (80%) and in good health (98% PS 0-1 and 97% having low degree of comorbidity (Charlson morbidity index 0-2). Overall, 28% were never smokers. 83% had oropharyngeal cancer (83% p16 positive).The aim was to reach at least 5 series of weekly cisplatin (in total ≥ 200mg), which was achieved in 69% of patients. Additionally, 16% received 4 series and 15% received ≤ 3 series. No significant correlation was found between cisplatin compliance and sex (p=0.06), tumour location (p=0.6) or T-stage classification (p=0.5). Compliance was reduced with increasing age (p=0.02), but especially in relation to the presence of one or more comorbidities (p<0.001) and worse performance (p<0.001). Compliance to planned radiotherapy was 99%. Six patients did not complete planned treatment due to competing medical unrelated disease. Major
Results: Results are shown in Table 1. Most patients not suitable for the dorsal mask were not able to lie flat on the couch. Patients receiving a face mask during treatment had too many treatment interrupts or were difficult to position. Removing parts of the ROI not relevant for PTV motion reduced the number of CBCT checks. The spreadsheet based approach also improved patient setup.
Conclusion: In routine clinical use, irradiation of H&N patients without a face mask but with the aid of SGRT for setup and intrafraction monitoring, remains as accurate as in a face mask. Patients with prior experience undergoing treatment while wearing a mask report to their physicians that treatment delivered without a mask is associated with significantly greater comfort. References: 1 Setup and intra-fractional motion measurements using surface scanning n head and neck cancer radiotherapy – a feasibility study. Essers M, Mesch L, Beugeling M, Dekker J, de Kruijf W. Phys Imaging Radiat Oncol.2024; 29, 100562. DOI:https://doi.org/10.1016/j.phro.2024.1005632 Goodbye face masks! Accurate head and neck radiotherapy using individual dorsal shells and surface guidance. Essers M, Mesch L, Beugeling M, de Wee E, Poorter R, Hamelink R, de Kruijf W. Radiother Oncol. 2025 Jul;208:110909. doi: 10.1016/j.radonc.2025.110909. Keywords: maskless, SGRT
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