S664
Clinical – Head & neck
ESTRO 2026
treated with volumetric modulated arc therapy (VMAT), using the telephone-administered 5-Minute Montreal Cognitive Assessment (MoCA 5-min). Material/Methods: In this cross-sectional study, 36 patients with locally advanced NPC treated at the oncology center of Jendouba Tunisia between 2020 and 2023 were included. All received VMAT to a total dose of 69.96 Gy in 33 fractions. Bilateral hippocampi were contoured on planning CT-MRI fusion images to extract mean (Dmean), maximum (Dmax), and dose to 40% of the volume (D40%) parameters. Cognitive function was assessed via telephone using the MoCA 5-min.The correlation between hippocampal doses and MoCA scores was analyzed using Pearson’s test. Results: Among the 28 patients who completed cognitive testing (77.8% response rate), 50% (n=14) showed mild cognitive impairment with MoCa score<26. The mean hippocampal Dmean was 16.15 Gy (range: 4.07–35.22 Gy).The mean Dmax was 40.93 Gy (4.89-70.74Gy) while the dose received by 40% of the hippocampal volume (D40%) was 15.70 Gy (2.05–43.16 Gy). A significant negative correlation was found between the D40% and MoCA 5-min scores (p=0.03), indicating higher dose to a substantial hippocampal volume was associated with worse cognitive performance. A trend towards significance was observed for Dmax (p=0.058). Notably, 71.4% of cognitively impaired patients received a hippocampal Dmean >15 Gy, though this correlation was not statistically significant Conclusion: Incidental hippocampal dose during VMAT for NPC, particularly the dose to a larger volume (D40%), is significantly correlated with cognitive decline. These findings highlight the importance of baseline and follow-up cognitive monitoring and support the clinical evaluation of hippocampal-sparing techniques to preserve cognitive function in NPC patients. Keywords: Nasopharyngeal Carcinoma ,Cognitive Function Extreme de-escalation to Elective Nodes in HNSCC treated with curative intent at a USA Community program: A Single-Institution Retrospective Analysis Adam Katzenberg 1 , Adam Raben 1 , Neil Hockstein 2 , Sujong Park 3 , Lydia Clements 3 , Julian Amin 2 , Lana DeSouza-Lawrence 1 1 Radiation Oncology, Helen F Graham Cancer Center, Christiana Care Health System, Newark, USA. 2 ENTAD, Helen F Graham Cancer Center, Christiana Care Health System, Newark, USA. 3 MOHC, Helen F Graham Cancer Center, Christiana Care Health System, Newark, USA Digital Poster 4719
Conclusion: PAT was successfully implemented as a routine treatment. Acute toxicities were mild and manageable. Preliminary results suggest slightly better treatment tolerance with PAT than with MFO; however, the limited sample size and short follow-up do not allow a definitive comparison. Further data and longer follow- up are needed to confirm these findings and clarify
PAT’s potential clinical advantages. Keywords: Proton therapy, Toxicity
Digital Poster 4689 Cognitive function and hippocampal dose in Nasopharyngeal Carcinoma patients treated with VMAT Hager Jaffel 1 , Oumaima Bouabidi 1 , yassmine daghfous 1 , Samia Ben Hssine 1 , wiem abid 1 , najet mahjoub 2 1 : Radiotherapy department of the oncology center of Jendouba, the oncology center of Jendouba, Jendouba, Tunisia. 2 Medical oncology department of the oncology center of Jendouba, the oncology center of Jendouba, Jendouba, Tunisia Purpose/Objective: Radiotherapy for nasopharyngeal carcinoma (NPC) delivers significant incidental dose to the hippocampi, a brain structure critical for memory and learning. This study investigates the correlation between hippocampal dose and cognitive function in patients
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