ESTRO 2025 Congress Report I Debate

By the ESTRO head-&-neck focus group

At the ESTRO 2025 congress, this debate underscored the evolving landscape of head-and-neck radiotherapy, balancing traditional approaches with innovative, patient-tailored strategies.

Debate overview

The session was chaired by Jon Cacicedo (Spain) and Pierluigi Bonomo (Italy). Speakers critically examined the traditional practice of elective nodal irradiation (ENI) in head-and-neck squamous cell carcinoma (HNSCC). Historically, ENI has been employed to control HNSCC in the neck by treating potential microscopic disease in regional lymph nodes. However, recent advancements in imaging, artificial intelligence-based risk modelling, and personalised treatment strategies have prompted a reevaluation of ENI’s necessity. 

Key Discussion Points

• Arguments for maintaining ENI: proponents (Professors Vincent Gregoire and Julian Biau) emphasised ENI’s role in reducing regional recurrence rates, and they cited its established efficacy in comprehensive disease control.
• Arguments for reducing use of or eliminating ENI: opponents (Profs Silke Tribius and Sue Yom) highlighted the potential to decrease toxicity and improve quality of life by omitting ENI, especially in patients with favourable risk profiles. They pointed to emerging evidence that supports the use of selective nodal irradiation, based on advanced imaging and risk assessment tools. 

 

 

 

 

Silke Tribius, MD, PhD

Radiation oncologist

Asklepios Tumorzentrum Hamburg

Chief Hermann-Holthusen Institut of Radiation Oncology

Chair of the European Organisation for the Research and Treatment of Cancer Head-and-neck Cancer Group
Member of the ESTRO head-&-neck focus group