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Purpose: Head and neck cancer (HNC) treatment often leads to physical and psychosocial impairments. Rehabilitation can overcome these limitations and improve quality of life. The aim of this study is to obtain an overview of rehabilitation care for HNC, and to investigate factors influencing rehabilitation provision, in Dutch HNC centers, and to some extent compare it to other countries. Methods: An online survey, covering five themes: organizational structure; rehabilitation interventions; financing; barriers and facilitators; satisfaction and future improvements, among HNC healthcare- and financial professionals of Dutch HNC centers. Results: Most centers (86%) applied some type of rehabilitation care, with variations in organizational structure. A speech language therapist, physiotherapist and dietitian were available in all centers, but other rehabilitation healthcare professionals in less than 60%. Facilitators for providing rehabilitation services included availability of a contact person, and positive attitude, motivation, and expertise of healthcare professionals. Barriers were lack of reimbursement, and patient related barriers including comorbidity, travel (time), low health literacy, limited financial capacity, and poor motivation. Conclusion: Although all HNC centers included offer rehabilitation services, there is substantial practice variation, both nationally and internationally. Factors influencing rehabilitation are related to the motivation and expertise of the treatment team, but also to reimbursement aspects and patient related factors. More research is needed to investigate the extent to which practice variation impacts individual patient outcomes and how to integrate HNC rehabilitation into routine clinical pathways. [ABSTRACT FROM AUTHOR]

The PEARL study is a phase 2 multi-centre trial for good prognosis HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) patients, currently open in the UK. PEARL is investigating the dosimetric impact of re-planning a radical radiotherapy plan midway through a course of treatment, based upon the biological response of the primary GTV on 18 FDG PET-CT. With the wider availability of proton beam therapy in the form of Intensity Modulated Proton Therapy (IMPT) as a potential option for radiotherapy in the management of OPSCC, in addition to substantial cost implications, improving methods to determine the patients who will benefit most from IMPT is required. The organ sparing benefits of IMPT are well documented. This modelling planning study investigated whether the benefits of proton therapy can be improved by applying biological response-based adaptation as per the PEARL study planning method. Objectives: 1. Investigate the dosimetric impact of IMPT by comparing mean dose received by swallowing OARs (SWOARs) between non-adaptive VMAT and non-adapted IMPT plans 2. Investigate the dosimetric impact of adaptation by comparing dose received by SWOARs between non-adaptive IMPT and adapted IMPT plans 3. Investigate the relative dosimetric impact of adaptation by comparing dose received by SWOARs between adaptive VMAT and IMPT plans 4. Identify whether adaptation as per the PEARL Study protocol would influence the delta normal tissue complication probability (ΔNTCP) threshold for proton beam therapy funding in The Netherlands Anonymized patient datasets were used to model VMAT and IMPT plans using RayStation and optimised for SWOARs. The following plans were generated: 1. 'NON-ADAPTIVE': Manually planned non-adapted VMAT 2. 'ADAPTIVE': Manually planned adapted VMAT 3. 'NON-ADAPTIVE_PROTON': Manually planned non-adapted IMPT 4. 'ADAPTIVE_PROTON': Manually planned adapted IMPT NTCP calculations for dysphagia risk we performed using the validated dysphagia model described by Christianen et al (1). Individual calculations were performed on each case comparing adapted and non-adapted VMAT plans to non-adapted IMPT plans to explore whether they reached the threshold for proton beam treatment funding as per The Netherlands scheme. Mean dose to the superior pharyngeal constrictor muscle and the supraglottis was entered into the following calculation: 1/NTCP = (1+ e)– s where s = -6.09 + (mean dose to the superior pharyngeal constrictor muscle x 0.057) + (mean dose to the supraglottis × 0.037) All cases had a reduction in their total mean dose to SWOARs, adapted as per PEARL, and planned with IMPT. The magnitude of impact was ranked in the same order for all cases, with optimisation reducing the total mean dose the least, and adapted IMPT the most. Cases 1 and 2, and Cases 3 and 4, demonstrated similar total mean dose reductions despite having different degrees of biological GTV reduction on the iPET-CT. Adaptation had the greatest impact on Cases 2 and 3 for both VMAT and IMPT plans. [Display omitted] The NTCP differences between non-adaptive VMAT plans and non-adaptive IMPT plans were >10% suggesting these cases would be candidates for IMPT funding as as per the National Indication Protocol Proton therapy (NIPP) - head and neck cancer criteria in The Netherlands. Whilst primarily limited by the small number of cases, we have demonstrated that IMPT markedly reduces doses to SWOARs compared to VMAT planning in line with widely published studies. We have also demonstrated that adaptation based on the biological response to the tumour after 2 weeks of chemoradiotherapy can further improve the tissue sparing already achieved with IMPT. This is the first study to demonstrate that SWOAR sparing by IMPT can be improved with biological response guided adaptive radiotherapy. Our results are in line with published data that IMPT can spare many head and neck SWOARs to a greater extent than VMAT in the treatment of oropharyngeal cancers. In the cases studied here, the impact of IMPT on the mean dose to SWOARs was greater than the impact of adaptation, when compared to standard VMAT planning. However, there may be additional dosimetric benefit when IMPT is adapted to tumour response during a course of radiotherapy treatment, particularly dose to more caudal SWOARs. In this small cohort, adaptation on VMAT plans was unlikely to have affected a decision for IMPT treatment as per the Netherlands NTCP-based algorithm. Further work with a larger cohort of patients, as well as real-time studies to collect prospective clinical data on xerostomia and dysphagia rates, is required to properly investigate the clinical advantages of adaptive IMPT. [ABSTRACT FROM AUTHOR]

Simple Summary: All patients suspected of having head and neck paragangliomas (HNPGLs) undergo magnetic resonance imaging (MRI) or computed tomography (CT) of the head and neck area as the standard imaging according to the Dutch guidelines. However, a relatively new imaging modality, [68Ga]Ga-DOTATOC PET/CT, has shown promising results in the detection of HNPGLs. In this pilot study, we aimed to compare the results of this new modality with the standard imaging. We compared both techniques in 25 patients at the University Medical Center Utrecht, The Netherlands. Twenty-eight percent of the patients had different outcomes between both modalities. In all cases, additional HNPGLs were identified using the [68Ga]Ga-DOTATOC PET/CT, suggesting the need for further prospective research to validate this finding. If confirmed, this modality could potentially be implemented as the standard of care for HNPGL detection in germline variant carriers. The Dutch guideline for patients suspected of head and neck paragangliomas (HNPGLs) recommends magnetic resonance imaging (MRI) and/or computed tomography (CT) of the head and neck area. Additionally, it suggests considering additional nuclear imaging. The aim of this study was to evaluate the outcomes of [68Ga]Ga-DOTATOC PET/CT compared to MRI in patients with suspected HNPGLs and carriers of genetic variations. Methods: In this single-center pilot study, retrospective data were obtained from consecutive patients between 2016 and 2023. Both MRI and [68Ga]Ga-DOTATOC PET/CT were performed within 12 months. The primary outcome was the location of HNPGLs. Results: A total of 25 consecutive patients were included, and 7 patients (28.0%, p = 0.5) showed differences between the imaging modalities, of whom 5 patients had unexpected localizations with additional uptake by somatostatin receptors (SSTR) on the [68Ga]Ga-DOTATOC PET/CT. Conclusions: The authors recommend performing baseline imaging with [68Ga]Ga-DOTATOC PET/CT (if available) in variant carriers and using MRI/CT for follow-up according to the regional protocol, thereby shifting the gold standard for baseline imaging from MRI/CT to [68Ga]Ga-DOTATOC PET/CT. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to quantify sentence-level articulatory kinematics in individuals treated for oral squamous cell carcinoma (ITOC) compared to control speakers while also assessing the effect of treatment site (jaw vs. tongue). Furthermore, this study aimed to assess the relation between articulatory-kinematic measures and self-reported speech problems. Method: Articulatory-kinematic data from the tongue tip, tongue back, and jaw were collected using electromagnetic articulography in nine Dutch ITOC and eight control speakers. To quantify articulatory kinematics, the two-dimensional articulatory working space (AWS; in mm² ), one-dimensional anteroposterior range of motion (AP-ROM; in mm), and superior-inferior range of motion (SIROM in mm) were calculated and examined. Self-reported speech problems were assessed with the Speech Handicap Index (SHI). Results: Compared to a sex-matched control group, ITOC showed significantly smaller AWS, AP-ROM, and SI-ROM for both the tongue tip and tongue back sensor, but no significant differences were observed for the jaw sensor. This pattern was found for both individuals treated for tongue and jaw tumors. Moderate nonsignificant correlations were found between the SHI and the AWS of the tongue back and jaw sensors. Conclusions: Despite large individual variation, ITOC showed reduced one- and two-dimensional tongue, but not jaw, movements compared to control speakers and treatment for tongue and jaw tumors resulted in smaller tongue movements. A larger sample size is needed to establish a more generalizable connection between the AWS and the SHI. Further research should explore how these kinematic changes in ITOC are related to acoustic and perceptual measures of speech. [ABSTRACT FROM AUTHOR]

Objective: To investigate utilization of mental healthcare among head and neck cancer (HNC) patients from diagnosis to 2 years after treatment, in relation to psychological symptoms, mental disorders, need for mental healthcare, and sociodemographic, clinical and personal factors. Methods: Netherlands Quality of life and Biomedical Cohort study data as measured before treatment, at 3 and 6 months, and at 1 and 2 years after treatment was used (n = 610). Data on mental healthcare utilization (iMCQ), psychological symptoms (Hospital Anxiety and Depression Scale, Cancer Worry Scale), mental disorders (CIDI interview), need for mental healthcare (Supportive Care Needs Survey Short‐Form 34, either as continuous outcome indicating the level of need or dichotomized into unmet need (yes/no)) and several sociodemographic, clinical and personal factors were collected. Factors associated with mental healthcare utilization were investigated using generalized estimating equations (p < 0.05). Results: Of all HNC patients, 5%–9% used mental healthcare per timepoint. This was 4%–14% in patients with mild‐severe psychological symptoms, 4%–17% in patients with severe psychological symptoms, 15%–35% in patients with a mental disorder and 5%–16% in patients with an unmet need for mental healthcare. Among all patients, higher symptoms of anxiety, a higher need for mental healthcare, lower age, higher disease stage, lower self‐efficacy and higher social support seeking were significantly associated with mental healthcare utilization. Conclusion: Mental health care utilization among HNC patients is limited, and is related to psychological symptoms, need for mental healthcare, and sociodemographic, clinical and personal factors. [ABSTRACT FROM AUTHOR]

Although, the 8th edition TNM (TNM8) significantly improved risk stratification of HPV-positive oropharyngeal carcinoma (HPV+ OPC) compared to the 7th edition TNM (TNM7) which was agnostic to tumor HPV status, undesirable heterogeneity still exists within each N category of the TNM8 classification, especially in cN1 disease. Compelling evidence suggests that image-identified extranodal extension (iENE) is prognostic in HPV+ OPC. The International Collaboration of Oropharyngeal cancer Network evaluated its role in refining the TNM8 cN classification in HPV+ OPC (ICON-N-HPV+). Curative-intent HPV+ OPC from 4 institutions in Canada, USA, and the Netherlands were included. cN+ patients were randomly allocated to Training (60%) and Validation (40%) datasets. All cases were staged according to TNM8. Pre-treatment (within 8 weeks of treatment commencement) CT/MRI were reviewed by radiologists for presence/absence of iENE (iENE+/iENE–) and other nodal features, including total lymph node (LN) number, laterality of neck nodes, presence of retropharyngeal LN [RPLN]) using a priori definition. Multivariable analysis (MVA) employing a step-wise approach evaluated the prognostic value of iENE and other nodal features for overall survival (OS) in cN+ patients in both Training and Validation datasets, adjusted for age, smoking, T-categories, N-categories, and treatment. We used the adjusted hazard ratio (AHR) and recursive-partitioning analysis (RPA) methods to derive cN-classifications that included nodal features that were significant in MVA. We evaluated the performance of stage schemas using the refined cN-classifications (including cN0) against TNM8 for hazard consistency, hazard discrimination, outcome prediction, and sample size balance. A total of 1898 cN+ (1139 Training; 759 Validation) and 155 cN0 patients were included. iENE+ patients accounted for 37% (710/1898) of cN+ patients. The Training dataset contained 435 (38%) iENE+ and 704 (62%) iENE– cases. iENE positivity increased with higher cN categories: 33% in N1, 43% in N2, and 82% in N3 diseases. Median follow-up was 5.1 years. The iENE+ cohort (vs iENE–) had inferior 5-year OS (69% vs 86%) vs iENE–. MVA confirmed that iENE was prognostic for both Training (Hazard ratio [HR] 2.72) and Validation (HR 1.90) datasets (p<0.001). RPLN and LN number (5+ vs 1-4) were also significant in univariable analysis but non-significant in MVA. We proposed to reclassify iENE+ cases one-stratum higher than that of the existing TNM8 cN, while iENE– either remained as TNM8 cN categories based on AHR model. To evaluate the performance of the stage schemas on OS and DFS, we reassembled cN+ and cN0 patients to create various stage groupings combining the T-categories with TNM8-N, AHR_N, and RPA_N schemas, respectively. The performance of stage grouping with AHR_N and RPA_N were similarly better than that of TNM8 for OS in both Training (1.23 and 1.17 vs 3.03) and Validation (0.85 and 0.37 vs 4.06) datasets. The 5-year OS for the entire cohort by TNM8 stage I/II/III were 89%/80%/62%, by AHR stage I/II/III were 92% vs 83% vs 64%, and by RPA stage I/II/III were 91%/81%/63%. These survival changes are evident in the relocation of higher risk disease with iENE to the higher stage groupings defined by the AHR_N and RPA_N models. This ICON-N-HPV+ study confirms the prognostic importance of iENE. We propose that iENE+ patients be reclassified one-stratum higher in the N categorization (similar to pN classification in HPV-negative head and neck cancer) while iENE– cases could either remain as per TNM-8 cN (AHR cN schema) or be amalgamated to form a new N1 (RPA cN schema) with consequent modification of the TNM stage groups. Since the AHR2 cN schema retains the TNM8 cN framework and is also consistent with current pN classification for non-viral head and neck cancer, it may be a more practical and less complicated proposal. T1-2_cN+_iENE– patients are potentially more appropriate candidates for deintensification trials while new strategies are needed to address the high risk of disease progression in iENE+ patients. [ABSTRACT FROM AUTHOR]

In this presentation, the following topics will be addressed: • Changes in health related quality of life over time from time of diagnosis to 2 years after treatment • Health related quality of life in relation to survival • What is the role of personal, clinical, biological, physical, psychological, social, lifestyle, and HNC-related factors? Data was used of The NETherlands QUality of life and BIomedical Cohort study in head and neck cancer (HNC) (NET-QUBIC) a prospective cohort study including 739 HNC patients and 262 informal caregivers. NET-QUBIC comprises a Data Warehouse and Biobank integrating detailed clinical information and data derived from patient reported outcomes, interviews, and functional tests, and samples of tumour tissue, blood, oral rinse, and saliva. Data and samples are available to researchers worldwide via data releases that are announced on www.kubusproject.nl. In the present study, we used NET-QUBIC data and samples to investigate the course of health related quality of life of HNC patients from diagnosis to 3, 6, 12 and 24 months after treatment. Health related quality of life was operationalised by the EORTC QLQ-C30 global quality of life subscale (2 items) and the summary score. [ABSTRACT FROM AUTHOR]

• The relation between Time to Treatment Initiation (TTI) and overall survival was confirmed with variation among different sites. • Advanced stage oral cavity cancers had a significantly better hazard of dying when the TTI of 37 days was not exceeded. • Head and neck cancer sites are characterized by considerable heterogeneity. To assess whether there are differences in the effects of time to treatment interval (TTI) on patient survival for head and neck cancer (HNC) sites in order to provide evidence that can support decision-making regarding prioritizing treatment. Patients in the Netherlands with a first primary HNC without distant metastasis between 2010 and 2014 were included for analysis (N = 10,486). TTI was defined as the time from pathologic diagnosis to the start of initial treatment. Overall survival (OS), cox regression analyses and cubic spline hazard models were calculated and visualized. Overall, the hazard of dying was higher (HR = 1.003; 95 % CI 1.001–1.005) with each additional day until treatment initiation. The pattern, as visualized in cubic spline graphs, differed by site the hazard increased more steeply with increasing TTI for oral cavity cancer. For oropharyngeal and laryngeal cancer, a slight increase commenced after a longer TTI than for oral cavity cancer, while there was hardly an increase in hazard with increasing TTI for hypopharyngeal cancer. The relationship between longer TTI and decreased survival was confirmed, but slight variations in the pattern of the hazard of dying by TTI by tumour site were observed. These findings could support decisions on prioritizing treatment. However, other aspects such as extent of treatment and quality of life should be investigated further so this can also be included. [ABSTRACT FROM AUTHOR]