ESTRO 2024 - Abstract Book

S122 ESTRO 2024 In summary, PRT reduces the dose to surrounding organs at risk and has therefore the potential to reduce the complication risks. Moreover, it preserves lymphocytes, which might result in improved tumor response and survival. These endpoints will be evaluated in the currently running randomized controlled trials (PROTECT and NRG-GI006) and will be validated in prospectively maintained cohorts, such as PROTRAIT. Invited Speaker

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The surgeon, for organ-sparing treatment approaches

Francesco Bussu

Università di Sassari, Medicine, Surgery and Pharmacy, Rome, Italy

Abstract:

• The role of surgeon in the era of tumor board

Surgery remains the most effective treatment modality in head and neck cancer, and the preferred primary treatment for SCC of the oral cavity, paranasal sinuses and larynx as well as of most non-SCC malignancies of the region. Besides it is by far the most effective modality for the salvage of the recurrences.

• Successful surgical organ/function preservation strategies

Such a preeminent role is also due to functional advantages over non-surgical modalities. We will present as examples our experience concerning the following aspects:

o Functional outcomes of partial, total and enlarged laryngectomies

We will describe our experience in cT3 laryngeal cancers comparing supracricoid laryngectomies with radiochemotherapy. DSS is not significantly different while organ preservation is 89% versus 55% in irradiated cases.

o Current surgical standards in oral cavity cancers

We will show functional possibilities of regional and free flap, allowing wide compartimental resections while restoring function.

o Salvage surgery of oropharyngeal recurrences

We will analyze the salvageability of recurrenc oropharyngeal SCC after irradiation, also in relation with HPV infection, which in our series has an impact also on salvageability and on prognosis after salvage, with a possible role for transoral robotic surgery. • Interventional radiotherapy, on the border between surgery and radiotherapy: the new standard for nasal vestibule malignancies However, in some cases the functional /cosmetic outcome after surgery is disappointing, as in the case of rhinectomies for nasal vestibule malignancies. In these cases, a brachytherapy approach, performed in close cooperation between surgeons and radiation oncologists warrants the best oncological and functional results. We present an Italian series of 70 cases treated between 2011 and 2023 with a 2-year nose preservation rate of 93% and a disease specific survival of 96%. The principles of implantation have been moved from the Paris system to anatomical criteria following the planes of rhinoseptoplasty, with the complete preservation of the cartilages of the nose tip.