S653
Clinical – Head & neck
ESTRO 2026
based study. Head & Neck. 2015 Jun;37(6):808- 14.Cooper JS, Guo MD, Herskovic A, Macdonald JS, Martenson Jr JA, Al-Sarraf M, Byhardt R, Russell AH, Beitler JJ, Spencer S, Asbell SO. Chemoradiotherapy of locally advanced esophageal cancer: long-term follow- up of a prospective randomized trial (RTOG 85-01). Jama. 1999 May 5;281(17):1623-7.Gkika E, Gauler T, Eberhardt W, Stahl M, Stuschke M, Pöttgen C. Long- term results of definitive radiochemotherapy in locally advanced cancers of the cervical esophagus. Diseases of the Esophagus. 2014 Oct 1;27(7):678-84. Keywords: chemoradiation , treatment toxicity ,local control target-prioritized IMRT for nasopharyngeal carcinoma abutting the spinal cord: clinical feasibility and long-term safety Yang Li, Wenxuan Huang, Lirong Wu, Han Gao, Lijun Wang, Shengfu Huang, Xia He Department of Radiation Oncology, Jiangsu Cancer Hospital, Nanjing, China Purpose/Objective: For locally advanced nasopharyngeal carcinoma (NPC) abutting the cervical spinal cord, conventional clinical practice often prioritizes strict spinal cord dose limits at the expense of target coverage. However, Digital Poster Highlight 4242 inadequate target dose compromises local control. Balancing target coverage and spinal cord protection therefore remains a major planning challenge. This study aimed to evaluate the safety and feasibility of a target-prioritized strategy—selectively relaxing spinal cord constraints to maintain curative target dose—in the era of modern IMRT/IGRT. Material/Methods: A total of 985 stage III–IVa NPC patients treated with definitive IMRT from 2012–2022 were retrospectively reviewed. Patients with a tumor–spinal cord distance ≤ 2 cm on MRI were identified (n = 146). Since 2012, a target-prioritized IMRT protocol has been applied: the planning goal for the spinal cord PRV was Dmax < 45 Gy, not exceeding 50 Gy whenever possible. Only when protocol-specified target coverage could not be achieved under these limits—confirmed independently by two senior physicists—were PRV constraints relaxed after detailed counseling and written informed consent, allowing Dmax of 54–60 Gy with strict micro-volume control and daily IGRT verification. Dosimetric parameters (PRV Dmax, D0.03cc, D1cc) and target coverage metrics (V95, D98) were extracted from dose–volume histograms. The primary endpoint was radiation myelopathy (RM). Secondary endpoints included local control, overall survival, and toxicity. Multivariable logistic regression
care university hospital. Material/Methods:
A retrospective review was conducted of patients aged over 18 years diagnosed with histologically proven squamous cell carcinoma of cervical esophagus who underwent definitive CRT at Aga Khan University
Hospital between 2011-2025. Demographic, treatment, and outcome data were analyzed. Results:
Total twenty-four patients diagnosed with cervical esophageal squamous cell carcinoma treated between 2011-2025 were identified from hospital database. Thirteen patients received definitive chemoradiotherapy (CRT) at our institution and were included in this analysis. The cohort included eight males and five females, with a median age of 41 years (range 15–62). Most presented with locally advanced disease (T3–T4, N0–2, M0). Chemotherapy regimens included Cisplatin/5-Fluorouracil (n=5), Carboplatin+Paclitaxel (n=4), Cisplatin alone (n=2), and an unknown regimen (n=2). Radiotherapy doses ranged from 5040–7000 cGy (median 7000), delivered using VMAT (n=8), IMRT (n=2), or 3DCRT (n=3) techniques.Complete response(CR) was achieved in 7 patients (54%), while 2 (15%) had progressive disease and 4 (31%) had undocumented response. Three-out- of-seven responders(43%) developed local recurrence and no distant failures were noted. Tumor size ranged from 35–90 mm (median 61 mm). Tumors <60 mm were more likely to achieve CR, while lesions ≥ 70 mm were associated with local recurrence or disease progression.At a median follow-up of 15 months (range, 3–58 months), 5 patients (38%) were alive without disease, 1 (8%) was alive with disease, 2 (15%) had died of progression, and 3 (23%) experienced treatment-related mortality (TRM). All TRM cases occurred in patients who received cisplatin/5- fluorouracil–based CRT, while no TRM was observed among those treated with carboplatin+paclitaxel, suggesting better tolerability of the latter regimen. Radiotherapy doses ( ≥ 6600 cGy) were associated with improved control but an increased need for post- treatment dilatation, whereas doses ≤ 6000 cGy correlated with local recurrence. Conclusion: Definitive chemoradiotherapy with Carboplatin+Paclitaxel and a radiotherapy dose( ≥ 66 Gy) was associated with improved survival and local control, though with increased need for post- treatment esophageal dilatation. Our cohort suggests a dose–response relationship. Given the paucity of local data from Pakistan, larger studies are needed to validate these findings and guide optimal treatment strategies. References: Grass GD, Cooper SL, Armeson K, Garrett–Mayer E, Sharma A. Cervical esophageal cancer: a population -
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