S666
Clinical – Head & neck
ESTRO 2026
critically on the treatment sequencing: perioperative, definitive concurrent, or neoadjuvant regimens. We systematically reviewed all RCTs and phase II/III studies to clarify comparative benefit and define new standards. Material/Methods: A systematic literature search of PubMed, Embase, and CENTRAL, as well as major oncology conference proceedings, was performed up to October 2025 (PRISMA methodology). Eligible studies included phase II or III randomized controlled trials and prospective studies evaluating ICIs combined with curative-intent radiotherapy, either in conjunction with surgery or as part of definitive chemoradiation. Primary outcomes were event-free survival (EFS), disease-free survival (DFS), or progression-free survival (PFS); secondary outcomes included overall survival (OS), major pathological response, and treatment-related toxicities. Dual independent reviewers performed data extraction and risk-of-bias assessment, and Bayesian network meta-analysis was applied. Results: Of 3,259 records identified, 73 full-text articles were reviewed, ultimately including 12 major trials (n = 4,987 patients) inclunding perioperative, neoadjuvant, and definitive treatment settings. Perioperative ICI strategies, as assessed in KEYNOTE-689 and NIVOPOSTOP, had the greatest impact, conferring a statistically significant reduction in the risk of recurrence and mortality (EFS/DFS HR 0.74, 95% CI 0.66–0.84; OS HR 0.75, 95% CI 0.66–0.86, both p < 0.001). In contrast, ICIs added concurrently to definitive chemoradiation provided no improvement in PFS (HR 0.98, 95% CI 0.85–1.13), and only a modest benefit in OS (HR 0.82, 95% CI 0.69–0.97). Neoadjuvant ICI monotherapy before surgery yielded high major pathological response and pathologic complete response rates (MPR 52%, pCR 23%) with manageable toxicity, but long-term survival data are still emerging. Across all strategies, perioperative ICI approaches were associated with a manageable increase in grade 3 or higher toxicities, with the safety profile remaining acceptable for routine practice. Conclusion: This review reveals a decisive therapeutic inflection point for immune checkpoint blockade in head and neck cancer. Integration of ICIs into the perioperative period, supported by robust phase III evidence, appears to mark a new standard in the curative management of resectable LA-HNSCC, offering durable gains in recurrence and survival. Altogether, these results underscore the profound impact of timing and treatment sequencing on the value of immune modulation in head and neck cancer. Keywords: LASCC, Immunotherapy, Systematic rewiew
Nineteen paragangliomas were evaluated—14 treated with CK and 5 with GK—for jugular (n=7), tympanicum (n=2), vertebral (n=3) and carotid body (n=7, Fig.1) paragangliomas. The most common SRT regimens was 12–20 Gy, 24 Gy, or 25 Gy in 1, 3, and 5 fractions, respectively. One patient was classified as Fisch A, one as Fish D and 6 patients as Fisch C. According to Shamblin classification, one and four patients reported type III and II paragangliomas, respectively. Median follow-up was 72 months (range: 11–107), and LC was achieved in 18/19 cases (94.7%). Median age was 58 years (range: 29–79) and median GTV was 5.6 cm ³ (range: 0.2–41). Symptomatic improvement occurred in 12 patients (63%). Four patients experienced acute TRAEs: grade (G) 1 dysphagia (1), G2 dysgeusia (1), G1 esophagitis (1) and G3 mucositis (1). One patient developed grade 1 late dysphagia. Conclusion: Our findings confirm that SRT using CK or GK provides excellent local control with minimal toxicity in patients with HN-PGs. Given the heterogeneity of tumor sites and clinical presentations, treatment should be individualized. Further prospective studies with larger cohorts are warranted to better define optimal dose- fractionation strategies and long-term outcomes. Keywords: Paragangliomas, stereotactic radiotherapy Immune Checkpoint Inhibitors in Locally Advanced Head and Neck Cancer: A Systematic Review and Network Meta-Analysis Carlotta Becherini, Viola Salvestrini, Marco Banini, Olga Ruggieri, Isacco Desideri, Emanuela Olmetto, Doruntina Cela, Vieri Scotti, Pierluigi Bonomo, Lorenzo Livi Radiation oncology Department - Careggi Hospital, University of FLorence, Florence, Italy Purpose/Objective: Integration of immune checkpoint inhibitors with radiotherapy is transforming curative strategies in locally advanced head and neck squamous cell carcinoma. However, their efficiency seems to depend Poster Discussion 4806
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