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Fuzzy Integral equations is a mathematical tool for modeling the uncertain control system and economic. In this paper, we present numerical solution of nonlinear fuzzy Volterra integral equations (NFVIEs) using successive approximations scheme and block-pulse functions. Additionally, the convergence analysis of the presented approach is investigated involving Lipschitz and several conditions and error bound between the approximate and the exact solution is provided. Finally, to approve the outcomes concerned with the theory a numerical experiment is considered. [ABSTRACT FROM AUTHOR]

The standard of care for locally advanced head and neck cancer (HNC) includes radiation with concurrent chemotherapy due to superior disease control. Older adults with HNC experience higher rates of morbidity, treatment breaks, hospitalizations, and death. New strategies are needed to better support older adults with HNC through radiation and chemotherapy to minimize treatment morbidity. Geriatric assessment (GA) can be used to identify patient-specific deficits and facilitate interventions to improve patient outcomes. In this randomized pilot clinical trial (NCT05239000), we hypothesize that use of geriatric assessment with or without comanagement can reduce the risk of hospitalization for older adults with HNC. Patients aged 65 and older with newly diagnosed or post-operative mucosal HNC with squamous cell histology are eligible for enrollment. All patients are planned for 6-7 weeks of radiation with concurrent chemotherapy. Enrolled patients complete an electronic GA before treatment, shortly following treatment, and 3-4 months after treatment. Patients are randomized between two groups: Arm 1 involves a geriatric consultation for management of geriatric-specific deficits; Arm 2 involves management of geriatric deficits by the radiation oncology team without geriatric consultation. All patients are seen twice weekly in radiation oncology clinic to enhance supportive care. Forty patients will be randomized equally between the two arms. The primary endpoint is the proportion of patients with unplanned hospitalization during the course of radiation therapy. The historic rate of hospitalization at Memorial Sloan Kettering Cancer Center is 44.6% for this cohort, and the study will be considered promising if there are 7 or fewer hospitalizations in either group. A secondary objective is to measure changes in GA before and after radiation and chemotherapy. The long term goal of this research is to identify new strategies that improve the care and outcomes of older adults with HNC receiving radiation and chemotherapy. TBD TBD [ABSTRACT FROM AUTHOR]

The incidence of Human Papilloma Virus (HPV) associated oropharyngeal cancer has risen rapidly over the past two decades with excellent prognosis and high rates of locoregional control. Post-treatment PET/CT for oropharyngeal cancer has a very high negative predictive value. Despite the improved outcomes for HPV-associated oropharyngeal cancer and the predictive value of post-treatment PET/CT, national guidelines for post-treatment surveillance of oropharyngeal cancer do not distinguish according to HPV status. The benefits and costs of various post-treatment surveillance regimens for patients with no evidence of disease on post-treatment PET/CT are unknown. Telemedicine with remote patient monitoring is a novel strategy to surveil patients while reducing the burden of traditional follow up regimens. This randomized clinical trial will test the hypothesis that tele-surveillance is non-inferior to standard surveillance for detection of progression-free survival (PFS) events (NCT05048459). Eligible patients have a diagnosis of HPV associated squamous cell carcinoma of the oropharynx with no evidence of disease on PET/CT imaging within 9 months of completing radiation therapy. No evidence of disease is a multi-disciplinary consensus determination by the patient's radiation, medical, and surgical oncologist. Patients are randomized 1:1 between standard surveillance according to institutional and national guidelines vs tele-surveillance with remote patient monitoring. Patients in the tele-surveillance arm have an annual tele-visit and remote patient monitoring every 6 months. All patients will complete the EORTC QLQ-C30, EORTC QLQ-HN43, and COST: A FACIT questionnaires annually as well as blood collection every 6 months for circulating tumor HPV DNA. The primary endpoint is 2-year PFS with a noninferiority margin of 12% for tele-surveillance. Sixty patients will be randomized between arms. Secondary endpoints include patient reported global and head and neck specific quality of life, locoregional control, distant metastases, overall survival, patient reported financial toxicity, cost of surveillance approach, physician and patient satisfaction, and detection of recurrence with circulating tumor HPV DNA. TBD TBD [ABSTRACT FROM AUTHOR]

Radiation treatment plans undergo peer review during chart rounds, but changes to treatment volumes would require replanning. Our group implemented weekly head and neck cancer "volume rounds" to peer review all target volumes for head and neck cancer prior to radiation therapy (RT) planning and chart rounds. We analyzed modifications made to planning target volumes (PTVs) at volume rounds for consecutive non-proton head and neck cancer cases from May 2020 to May 2021. Nine head and neck radiation oncologists participated in weekly volume rounds during this time. Recommendations were categorized as no changes, minor changes, major changes, additional workup (e.g., biopsy or imaging), and consultation or tumor board discussion needed prior to the start of RT. Minor changes to PTVs generally did not require a second review prior to treatment planning while major changes did. PTVs for 511 cases involving 432 patients underwent peer review and 298 (58.3%) of these cases did not require any modifications prior to treatment planning. Minor and major changes were recommended in 75 (14.7%) and 86 (16.8%) cases, respectively. Additionally, 45 (8.8%) cases were recommended to have further workup and 23 (4.5%) required further consultation with other non-radiation oncology services. Of the 45 cases that were recommended for further workup, 40 underwent biopsy or imaging. Positive findings on imaging or biopsy occurred in 13 patients leading to a significant change in management, including 4 patients that underwent further surgery after positive findings prior to the start of RT. Prospective peer review during head and neck cancer volume rounds led to frequent minor and major alterations to PTVs. Significant changes in the overall treatment plan, such as additional surgery prior to start of RT, occurred in a minority of patients. [ABSTRACT FROM AUTHOR]

Background Previous studies have found that overestimating treatment effects (i.e. 'optimism bias') leads to underpowered clinical trials. The prevalence of 'optimism bias' in contemporary National Clinical Trials Network (NCTN) cancer clinical trials is unknown. Methods We conducted a systematic review of NCTN phase III randomized trials published from January 2007 to January 2017. We compared the hypothesized versus observed treatment effects in each trial, and examined whether trial-related factors were correlated with the study results. We also reviewed the methods of each protocol to assess whether a rationale for the hypothesized effect size was provided. Results We identified 161 clinical trials, of which 130 were eligible for analysis. Original protocols could not be located for 8 trials (5.0%). Twenty-eight trials (21.5%) observed a statistically significant difference in the primary end point favoring the experimental treatment. The median ratio of observed-to-expected hazard ratios among trials that observed a statistically significant effect on the primary end point was 1.07 (range: 0.33–1.28) versus 1.32 (range: 0.86–2.02) for trials that did not, compared with 1.34 and 1.86, respectively, for National Cancer Institute (NCI) trials published between 1955 and 2006. An effect size at least as large as the one projected in the protocol trials was observed in 9.8% of trials, compared with 17% of NCI trials published from 1955 to 2006. Most trials (64.6%) provided no rationale to support the magnitude of the proposed treatment effect in the protocol. Conclusions Despite a reduction in 'optimism bias' compared with previous eras, most contemporary NCTN phase III trials failed to establish statistically significant benefits of new cancer therapies. Better rationalization of proposed effect sizes in research protocols is needed. [ABSTRACT FROM AUTHOR]

There is a lack of consensus on what is the preferred systemic regimen in combination with radiation therapy for cisplatin-ineligible patients with locally advanced head and neck squamous cell carcinoma (HNSCC). We report the outcomes of cisplatin-ineligible patients with HNSCC treated with definitive radiation therapy and weekly concurrent carboplatin and paclitaxel at our institution. We included consecutive HNSCC patients treated from 2013 to 2021 that received definitive radiation therapy with weekly carboplatin and paclitaxel for oropharynx, larynx, hypopharynx and unknown primary cancers. We excluded patients who received induction chemotherapy or re-irradiation and patients who had multiple or synchronous primary malignancies. Locoregional control (LRC) and distant control (DC) were estimated using cumulative incidence functions while progression free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier methods. Sixty-six patients were identified with median age of 70 years (range 44 – 85). Disease sites included oropharynx (n=44), larynx (n=15), hypopharynx (n=5), and unknown primary cancer (n=2). Thirty-five patients (53%) had HPV+ disease. Thirty-three patients had T3 or 4 disease (50%) and 48 (72.7%) had N2 or 3 disease. Median radiation dose received was 70 Gy and the median doses of carboplatin and paclitaxel were AUC 1 and 40 mg/m2. Patients received a median of 7 cycles of chemotherapy. At a median follow up of 22 months (range 0.5 – 83.6), the 2-year rates of LRC, DC, PFS, and OS rates were 90.4%, 93.5%,78% (95% CI: 67% – 90%) and 88% (95% CI: 80% - 97%), respectively. There were 4 locoregional failures, 5 distant metastases, and 11 deaths. However, 9/11 deaths occurred in patients without local or distant recurrence. The majority of these deaths were attributed to other medical causes such as upper gastrointestinal bleeds, severe ulcerative colitis, and myocardial infarction. There was one patient with difficulty breathing due to prominent treatment related mucosal edema, which resulted in sudden expiration. Radiation therapy with weekly carboplatin and paclitaxel is an option for HNSCC patients who are cisplatin-ineligible. Randomized trials are needed to compare carboplatin and paclitaxel with other systemic regimens for this population. [ABSTRACT FROM AUTHOR]

The thickness- and temperature-dependent irreversible change of morphology and magnetic parameters of 5 and 10 monolayers (ML) of Fe on GaAs(001) are investigated by scanning tunnelling microscopy, low energy electron diffraction, ferromagnetic resonance and magnetometry in ultra-high vacuum. After heating to 550 K (5 ML) or 650 K (10 ML) large flat islands form which have the same vertical layer spacing as the continuous film. The morphological change is reflected in a change of the magnetic anisotropy parameters by a factor of up to 5 in the case of cubic and by a reduction of up to 20% for the overall uniaxial anisotropy contributions. The magnetization of the film did not change after the transformation. These results are explained by the increased number of steps leading to an increase of the shape anisotropy, which in turn reduces the overall uniaxial out-of-plane anisotropy. [ABSTRACT FROM AUTHOR]

Proton therapy (PT) has a potential advantage over intensity-modulated radiation therapy (IMRT) in the treatment of oropharyngeal carcinoma (OPC) due to reduction of dose to the surrounding organs at risk. Our objective was to compare adverse effects and oncologic outcomes in patients with OPC treated with PT vs. IMRT This retrospective cohort study included 292 consecutive patients with newly diagnosed non-metastatic OPC who received curative-intent radiation with PT or IMRT from 2018 to 2021. Clinical and demographic details were compared between the two groups. The main outcomes were the incidence of acute and chronic treatment-related adverse events (AEs), and oncologic outcomes, including locoregional recurrence (LRR), progression-free survival (PFS), and overall survival (OS). 58 PT and 234 IMRT patients were included. The median follow-up for all patients was 26 months (2-88mo). Median RT dose was 70 CGE (Gy) (range 66-78 CGE, 64-76 Gy). There were no imbalances in patient/tumor characteristics except for smoking pack-years (PY) (mean 7.4 PYs PT and 13.2Pys IMRT, p=.002), and N-stage (N0 17% PT versus 7% IMRT, N1 5% PT versus 15% IMRT, p=.04). There were no significant differences in T-stage or use of concurrent chemotherapy between PT and IMRT groups. 98% of patients in PT group were p16 or HPV+ versus 92% in the IMRT group. Statistically significant differences were not observed in 3 year overall-survival (91% IMRT, 97% PT, p=0.166), PFS (86% IMRT, 82% PT, p=.984) or LRR (3% IMRT, 5% PT, p=0.369).Using chi-square analysis, acute toxicities were statistically significantly higher for IMRT compared to PT for acute grade ≥2 oral pain (92.8% IMRT vs 72.4%PT p<.001), acute grade ≥2 xerostomia (29 % IMRT versus 21% PT, p<.001), acute grade ≥2 dysgeusia (57% IMRT versus 28% PT, p<.001), grade 3 dysphagia (12% (29) IMRT versus 7% (4) PT p<.001), grade ≥3 mucositis (70% IMRT versus 53% PT, p=.003), grade ≥2 nausea (7.7% IMRT versus 0% PT, p=.04), and grade ≥2 weight loss (59% IMRT, versus 37% PT, p<.001). When excluding patients with follow-up less than 6 months, 221 IMRT and 43 PT patients remain. There were no significant differences in grade ≥2 late toxicities between the two groups. When looking at the presence of any toxicity, at ≥ 6 months follow-up, there was a significant difference in the presence of xerostomia (77% IMRT versus 61% PT, p=.026). Four patients (1.7%) in the IMRT group, versus 1 patient (1.7%) in PT group had a PEG at a follow-up of at least 6 months. All late PEG tubes were due to recurrent/refractory disease PT for non-metastatic OPC reduces acute toxicity burden in comparison with IMRT with similar oncologic outcomes. Prospective randomized comparisons of these two technologies in the treatment of OPC along with patient-reported outcomes are warranted to confirm our results. [ABSTRACT FROM AUTHOR]

Human papilloma virus (HPV)-associated oropharynx squamous cell carcinoma (OPC) is associated with excellent outcomes and has led to de-escalation efforts to reduce treatment toxicity. In the post-operative setting, adjuvant therapy is recommended based on traditional pathologic factors and additional biomarkers are needed to select optimal candidates for therapy de-escalation. Cell-free tumor DNA (ctDNA) is an emerging method of cancer surveillance and detecting minimal residual disease. HPV ctDNA can be detected prior to clinically apparent recurrence. In our pilot study we hypothesize that undetectable post-operative HPV ctDNA can be used to select patients for active surveillance, in which adjuvant radiation is omitted or delayed until patients develop detectable HPV ctDNA (cohort A). We also hypothesize that undetectable HPV ctDNA can be used to select for post-operative chemoradiation de-escalation to 30 Gy with concurrent chemotherapy (cohort B) in patients with positive margins or extracapsular extension (NCT05307939). Subjects are eligible for trial enrollment if they have: detectable pre-operative HPV-16 ctDNA (min 50 copies/mL), undergone surgical resection of all gross disease, and undetectable post-operative HPV ctDNA. All patients must also have a minimum of one of the following pathologic criteria: AJCC 7 pT1N1/pT2N1/pT3 disease, N2 disease, unknown primary (pT0N1-2b) status post neck dissection, lympho-vascular invasion (LVI), peri-neural invasion (PNI), or close margin (<3 mm), microscopic positive margin, or extracapsular extension (ECE). Patients who meet the aforementioned criteria who do not have positive margins or ECE are eligible for active surveillance (Cohort A) without immediate adjuvant therapy. Patients with microscopic positive margins or extracapsular extension are eligible for immediate de-escalated adjuvant chemoradiation (Cohort B). During active surveillance, Cohort A patients are observed and are treated with delayed adjuvant radiation if they develop detectable HPV ctDNA without radiographic evidence of disease. Patients with microscopic positive margins or extracapsular extension are treated with de-escalated post-operative chemoradiation: 30 Gy in15 fractions with concurrent chemotherapy (bolus cisplatin or carboplatin/5-fluorouracil). The primary objective is to evaluate the one year pathologically confirmed PFS (n=30). For each cohort, if at least eighty-five percent of evaluable patients are disease progression-free and alive at the end of one year of follow-up, the cohort will be declared promising and worthy of further investigation. Secondary objectives include evaluating one and two year locoregional PFS, one and two year overall survival, HPV ctDNA PFS patient report quality of life, and patient reported financial toxicity. TBD TBD [ABSTRACT FROM AUTHOR]

Human papilloma virus cell-free tumor DNA (HPV ctDNA) may be able to detect minimal residual disease prior to clinically apparent recurrence. We hypothesized that undetectable post-operative HPV ctDNA can be used to select patients for active surveillance and conducted a pilot study (NCT05307939) omitting or delaying adjuvant radiation until patients develop detectable HPV ctDNA (cohort A). HPV ctDNA was assessed using a liquid biopsy assay which quantifies circulating tumor tissue modified viral (TTMV)-HPV DNA. Eligible subjects had a preoperative TTMV-HPV DNA Score of ≥50 fragments/mL, underwent surgical resection of all gross disease confirmed by post-operative MRI, had a minimum of one pathologic risk factor for adjuvant therapy, and negative post-operative HPV ctDNA at two draws 2-6 weeks after surgery. During active surveillance, patients were monitored with TTMV-HPV DNA testing, imaging, and exam every 3 months (mo). Patients were only treated with delayed adjuvant radiation on study if they develop detectable TTMV-HPV DNA without evidence of gross disease. Our primary endpoint declares this approach worthy of further study if ≥ 85% of evaluable patients (n=15 in each cohort) are gross disease progression-free at one year. From 3/23/22-8/25/23, 53 patients were screened and 12 patients enrolled on Cohort A before early enrollment closure. Patients were excluded due to TTMV-HPV DNA Score <50 frag/mL (n=21) and positive margin or extracapsular extension (n=11) inclusive of n=2 patients with a positive post-operative TTMV-HPV DNA score. Among patients enrolled in Cohort A, the median pre-treatment TTMV-HPV DNA Score was 448 (Range: 59-2135 frag/mL). Median follow-up was 12.5 mo (Range: 3.7-21 mo). TTMV-HPV DNA was detected during surveillance in 1 of 12 initially enrolled patients 6 mo after surgery without evidence of gross disease, and the patient was treated with 60 Gy of adjuvant radiotherapy on study. 3 additional patients developed radiographic detected disease progression at the 6-mo surveillance time point, and recurrence occurred either synchronously (n=2) with or before TTMV-HPV DNA was detected (n=1). As 3 of 12 patients developed gross recurrent disease, Cohort A closed due to failure to meet our primary endpoint. Cohort B (de-escalated post-operative therapy) remains open and will be reported separately. Our pilot study approach of using HPV ctDNA based selection of patients for post-operative active surveillance resulted in a high rate of gross disease recurrence and failed to meet our primary endpoint. Radiographic recurrence was not preceded by detectable TTMV-HPV DNA during 3 mo interval surveillance, and additional clinical factors are needed to select patients for active surveillance and initiation of delayed adjuvant therapy prior to recurrence. [ABSTRACT FROM AUTHOR]

Post-treatment surveillance imaging for HPV-associated oropharyngeal carcinomas (OPCs) differs among physicians and institutions. Surveillance imaging can detect disease progression earlier, but can also contribute to anxiety and cost, without proven disease-free or survival benefit. We sought to determine the number of surveillance scans needed to detect a recurrence in patients with HPV-associated OPCs. We included consecutive patients with locally advanced HPV-associated OPC that received definitive concurrent chemoradiotherapy (CRT) with 70 Gy between March 1, 2017 to July 31, 2019. First post-treatment scans were defined as the first scans following the end of CRT. Surveillance scans were defined as body FDG PET/CTs, neck or chest CTs, and neck MRIs taken after the first post-treatment scans showed no evidence of disease. Any scans ordered to follow suspicious lesions on first post-treatment scans were not counted as surveillance scans. Recurrences were classified as detected by first post-treatment scans, surveillance scans, clinical exam, or incidental findings. The number of surveillance scans needed to detect 1 recurrence was determined by dividing the number of surveillance scans by the number of recurrences detected by surveillance scans. There were a total of 275 patients with median follow-up of 39.8 months (Interquartile Range (IQR), 34.9-47.8). Surveillance scans were first taken at a median of 12.1 months (IQR, 9.2-16) post-CRT. There were 27 (9.8%) patients who had a recurrence: 7 (2.5%) had locoregional recurrence (LR), 19 (6.9%) had distant metastasis (DM), and 1 (0.4%) had both LR and DM. LR was detected at a median of 5.8 months (IQR, 3.4-10.6) post-CRT and DM was detected at a median of 9.5 months (IQR, 4.8-14.3) post-CRT. Of all recurrences, 11/27 (40.7%) were first post-treatment scan detected, 10 (37.0%) were surveillance scan detected, 5 (18.5%) were clinical exam detected, and 1 (3.7%) was incidentally detected on lung cancer screening. Four (50%) LRs were first post-treatment detected (median time to detection, MTD: 4.2 months), 3 (37.5%) were clinical exam detected (MTD: 6.7 months), and 1 (12.5%) was surveillance detected (MTD: 9.0 months). For DM, 9 (45%) were surveillance detected (MTD: 12.7 months), 8 (40%) were first post-treatment detected (MTD: 4.1 months), 2 (10%) were clinical exam detected (MTD: 18.9 months), and 1 (5%) was incidentally detected (MTD: 12.1 months). A total of 702 surveillance scans were taken during the follow-up period. The number of surveillance scans needed to detect 1 LR/DM was 71 overall, 50 within 2 years and 254 beyond 2 years from CRT. First post treatment scans detect most recurrences for HPV-associated OPC. A high burden of surveillance scans is needed to detect one recurrence, especially beyond 2 years from CRT. [ABSTRACT FROM AUTHOR]

Adaptive head and neck radiotherapy has shown great promise in ensuring delivered dose matches physician intent. Optimal points for adaptation are still unknown and replanning is always a balance between clinical benefit and resources. In this work we explore a gross tumor volume (GTV) based trigger, enabled by in-house automation software, that alerts the clinical team of significant changes in the GTV to aid in their decisions regarding adaptive replanning. Twenty-eight patients with mainly cancer of the oropharynx receiving definitive radiotherapy with no resection were included. Patients with visibly bulky primary or nodal disease were selected and prescription dose to the high-risk planning target volume (PTV) was 70Gy in 33/35 fractions. All patients were scheduled on an in-house software program called AWARE (Automated Watchdog for Adaptive Radiotherapy Environment) that automatically tracks preselected structures for volume changes on weekly CBCTs. GTVs were tracked and a change in GTV greater than 20% triggered a resimulation and a discussion with the physician regarding the need for adaptation. Absent 20% changes, all patients were resimulated 3 weeks after the start of treatment. If deemed clinically necessary following resimulation, the patient was replanned. The treatment timeline was recorded for each patient including the AWARE trigger point which was compared between adapted and non-adapted patients. For adapted patients the dose to the organs at risk and PTVs were compared between what would have been delivered with the old plan on the resimulation scan and the dose that was delivered with the replan on the resimulation. Finally, the correlation between the AWARE-tracked GTV change and the PTV change in the adapted plan was determined. Of the 28 patients that were tracked, 16 received an adaptive plan. On average, the resimulation occurred 23 days [range: 14-30] after treatment start and the adaptive plan was treated for 11.5 fractions [range: 9-20]. Of the 16 patients that were treated with an adaptive plan, 13 (81%) reached the AWARE trigger by end of week 4. By comparison only 2 out of 12 (17%) patients that were not adapted reached the trigger. Adaptation resulted in a statistically significant decrease in the mean dose to the submandibular glands and the oral cavity (p-value < 0.002). In 3 patients the PTV coverage increased by more than 10% with the adapted plan. The correlation between AWARE tracked GTV and the PTV change was 0.68 (p-value=0.004). Our initial experience with automated tracking shows that it can provide triggers that agree well with the decision to adapt and changes in the resimulated target volumes. Once adapted, the dosimetric benefit for minimizing dose delivered to the normal tissue can be highly significant. This can translate into meaningful toxicity reduction, while an adaptive plan can also improve coverage to the target when changes occur. [ABSTRACT FROM AUTHOR]

The article discusses a conference paper about gene expression studies in oncology, presented at the International Conference for Healthcare and Medical Students (ICHAMS) held in Dublin, Ireland from October 11-12, 2013. It examines composite endpoints in gene expression studies in oncology. It mentions use of event-free survival (EFS) endpoints in cancer gene expression studies to evaluate the effects of gene expression on patient outcomes.

Purpose/objective(s): The COVID-19 pandemic triggered a national emergency which drastically affected the practice of medicine. Studies have already shown that delays in cancer screening/diagnosis/treatment have ensued, and some project this will translate into increased mortality. We aimed to evaluate if early oropharyngeal cancer (OPC) outcomes with radiation therapy (RT) were affected.Materials/methods: On 3/17/2020, in response to the crisis in New York City, telemedicine consultations were implemented at our institution and patients followed prospectively. The Covid cohort (COV) includes new patients through July 2020. They were compared to a contemporary pre-Covid (PC) historical cohort of new patients from November 2019 to 3/16/2020. We reviewed medical records and collected clinicopathologic factors for OPC patients treated with curative intent RT. The Kaplan-Meier method was used to estimate time-to-event outcomes.Results: Median follow-up was 8.6 [1.0-13.8] months for all (5.8 months COV, 10.1 months PC). Both cohorts encompassed ∼19 weeks, but half as many consults were seen during the pandemic (n = 38 COV, n = 78 PC). The COV cohort included: 74% telehealth, 92% definitive RT (no surgery), and 89% chemoRT. The PC cohort included: 0% telehealth, 88% definitive RT (no surgery), and 94% chemoRT. There was no difference in COV vs. PC median times from consultation to simulation (1.1 [0-6.4] weeks vs. 1.4 [0-10.6] weeks) or simulation to RT start (2.1 [1.3-4.9] weeks vs. 2.0 [1.1-9.9] weeks). There was no difference in 6 month outcomes between COV vs. PC cohorts: local control (100% vs. 100%, P = 0.70), regional control 100% vs. 100%, P = 0.70), distant control (95.2% vs. 97.2%, P = 0.91), cancer-specific survival (100% vs. 98.7%, P = 0.48). There was no difference in outcomes between telemedicine vs. in-person consults. There were numerically more patients with very advanced disease during the pandemic: T4 (13.2% COV vs. 7.7% PC) or N3/M1 (5.2% COV vs. 2.6% PC), but differences were not statistically significant due to limited numbers. More patients treated during the pandemic developed grade 3 dysphagia requiring feeding tubes (10.5% COV vs. 5.1% PC), not significant due to limited numbers. No patients diagnosed with COVID (1 before, 2 during, and 5 after RT) had recurrence at last follow-up.Conclusion: There was no difference in early 6 month outcomes between COV and PC cohorts, no difference in outcomes with telemedicine, and RT delivery was sustained at pre-pandemic timelines. Several important clinical trends were identified in the COV cohort: about half as many consultations were seen during the pandemic, patients appeared more likely to present with very advanced disease, and more patients required feeding tubes during treatment. These findings may have important post-pandemic healthcare delivery implications related to delays in diagnosis, threats to long-term outcomes, and increased supportive care needs. [ABSTRACT FROM AUTHOR]