[Online adaptive irradiation of a p16+ bulky head/neck cancer patient at the National Institute of Oncology].

A 48-year-old male patient with a large (T3N3M0) p16 positive meso-hypopharyngeal tumor was hospitalized in our department for radiotherapy. The standard of care for this disease would have been radio-chemotherapy, but given the extent of the disease, we opted for palliative radiotherapy alone. Because of the patient’s p16 positivity, we assumed a high tumor response, so we offered the option of online adaptive radiotherapy, for the first time in our country. The patient accepted the treatment, which meant that we were able to carry it out by taking a cone-beam CT scan every day, which allowed us to redraw the target volumes and the organs to be protected, and create a new irradiation plan. The patient received a 10-fraction treatment without any significant side effects, and his existing symptoms of the disease were reduced. Due to the great improvement of the patient’s general condition and the significant regression of the target volume, we were able to complete the treatment up to the definitive dose. At the follow-up MRIs and CTs at 1, 2, 3, and 6 months, further high regression was reported in the treated region without distant metastasis. Compared to the high-fraction-dose treatment performed, we observed an excellent side effect profile based on quality of life questionnaires. We successfully completed the first online adaptive head and neck tumor treatment in Hungary. Orv Hetil. 2025; 166(32): 1265–1270.