{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T04:17:03Z","timestamp":1783397823669,"version":"3.54.6"},"reference-count":34,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T00:00:00Z","timestamp":1774396800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010441","name":"Heidelberg University Medical Faculty Heidelberg","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010441","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","ctro.science","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Clinical and Translational Radiation Oncology"],"published-print":{"date-parts":[[2026,7]]},"DOI":"10.1016\/j.ctro.2026.101156","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T03:28:05Z","timestamp":1775100485000},"page":"101156","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":0,"special_numbering":"C","title":["De-escalation of elective radiotherapy guided by FDG-PET lowers modeled late swallowing-related toxicity in head and neck cancer"],"prefix":"10.1016","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5099-3221","authenticated-orcid":false,"given":"Florian","family":"Stritzke","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Dvornikovich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4854-1514","authenticated-orcid":false,"given":"Hin","family":"Lau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Tessonnier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5584-9748","authenticated-orcid":false,"given":"Philipp","family":"Schr\u00f6ter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Neugebauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5805-0535","authenticated-orcid":false,"given":"Nils","family":"Netzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7711-934X","authenticated-orcid":false,"given":"Lukas","family":"Bauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rubens","family":"Th\u00f6lken","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Winter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1195-7150","authenticated-orcid":false,"given":"Semi","family":"Harrabi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Mairani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uwe","family":"Haberkorn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6411-4811","authenticated-orcid":false,"given":"J\u00fcrgen","family":"Debus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Held","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.ctro.2026.101156_b0005","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.adro.2019.07.015","article-title":"Long-Term aspects of quality of life in head and neck cancer patients treated with intensity modulated radiation therapy: a 5-year longitudinal follow-up and comparison with a normal population cohort","volume":"5","author":"Abel","year":"2020","journal-title":"Adv Radiat Oncol"},{"key":"10.1016\/j.ctro.2026.101156_b0010","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1016\/j.oraloncology.2014.09.009","article-title":"Patient-reported outcomes following parotid-sparing intensity-modulated radiotherapy for head and neck cancer. How important is dysphagia?","volume":"50","author":"Roe","year":"2014","journal-title":"Oral Oncol"},{"key":"10.1016\/j.ctro.2026.101156_b0015","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1016\/j.clon.2014.08.009","article-title":"Persistent dysphagia after head and neck radiotherapy: a common and under-reported complication with significant effect on non-cancer-related mortality","volume":"26","author":"Szczesniak","year":"2014","journal-title":"Clin Oncol (R Coll Radiol)"},{"key":"10.1016\/j.ctro.2026.101156_b0020","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.radonc.2011.08.009","article-title":"Predictive modelling for swallowing dysfunction after primary (chemo)radiation: results of a prospective observational study","volume":"105","author":"Christianen","year":"2012","journal-title":"Radiother Oncol"},{"key":"10.1016\/j.ctro.2026.101156_b0025","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1002\/hed.26936","article-title":"Functional swallowing outcomes related to radiation exposure to dysphagia and aspiration-related structures in patients with head and neck cancer undergoing definitive and postoperative intensity-modulated radiotherapy","volume":"44","author":"Charters","year":"2022","journal-title":"Head Neck"},{"key":"10.1016\/j.ctro.2026.101156_b0030","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1016\/j.ijrobp.2009.04.087","article-title":"NTCP modeling of subacute\/late laryngeal edema scored by fiberoptic examination","volume":"75","author":"Rancati","year":"2009","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"10.1016\/j.ctro.2026.101156_b0035","doi-asserted-by":"crossref","first-page":"e351","DOI":"10.1016\/j.ijrobp.2012.05.020","article-title":"A prospective cohort study on radiation-induced hypothyroidism: development of an NTCP model","volume":"84","author":"Boomsma","year":"2012","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"10.1016\/j.ctro.2026.101156_b0040","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1016\/j.ijrobp.2009.07.1708","article-title":"Parotid gland function after radiotherapy: the combined michigan and utrecht experience","volume":"78","author":"Dijkema","year":"2010","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"10.1016\/j.ctro.2026.101156_b0045","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.radonc.2012.03.004","article-title":"NTCP models for patient-rated xerostomia and sticky saliva after treatment with intensity modulated radiotherapy for head and neck cancer: the role of dosimetric and clinical factors","volume":"105","author":"Beetz","year":"2012","journal-title":"Radiother Oncol"},{"key":"10.1016\/j.ctro.2026.101156_b0050","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/S1470-2045(10)70290-4","article-title":"Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial","volume":"12","author":"Nutting","year":"2011","journal-title":"Lancet Oncol"},{"key":"10.1016\/j.ctro.2026.101156_b0055","doi-asserted-by":"crossref","DOI":"10.1016\/j.radonc.2023.109973","article-title":"Treatment planning comparison for head and neck cancer between photon, proton, and combined proton-photon therapy - from a fixed beam line to an arc","volume":"190","author":"Amstutz","year":"2024","journal-title":"Radiother Oncol"},{"key":"10.1016\/j.ctro.2026.101156_b0060","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1016\/j.oraloncology.2015.01.004","article-title":"(18)FDG-PET\/CT for the detection of regional nodal metastasis in patients with head and neck cancer: a meta-analysis","volume":"51","author":"Sun","year":"2015","journal-title":"Oral Oncol"},{"key":"10.1016\/j.ctro.2026.101156_b0065","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1016\/j.oraloncology.2011.03.018","article-title":"Combined [18F]fluorodeoxyglucose positron emission tomography and computed tomography for detecting contralateral neck metastases in patients with head and neck squamous cell carcinoma","volume":"47","author":"Kim","year":"2011","journal-title":"Oral Oncol"},{"key":"10.1016\/j.ctro.2026.101156_b0070","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.radonc.2020.01.005","article-title":"Randomized clinical trial on reduction of radiotherapy dose to the elective neck in head and neck squamous cell carcinoma; update of the long-term tumor outcome","volume":"143","author":"Deschuymer","year":"2020","journal-title":"Radiother Oncol"},{"key":"10.1016\/j.ctro.2026.101156_b0075","doi-asserted-by":"crossref","first-page":"3284","DOI":"10.1158\/1078-0432.CCR-23-0334","article-title":"Efficacy and quality-of-life following involved nodal radiotherapy for head and neck squamous cell carcinoma: the INRT-AIR phase II clinical trial","volume":"29","author":"Sher","year":"2023","journal-title":"Clin Cancer Res"},{"key":"10.1016\/j.ctro.2026.101156_b0080","doi-asserted-by":"crossref","first-page":"2583","DOI":"10.1200\/JCO-24-02194","article-title":"Clinical benefit and safety of reduced elective dose in definitive radiotherapy for head and neck squamous cell carcinoma: the UPGRADE-RT multicenter randomized controlled trial","volume":"43","author":"van den Bosch","year":"2025","journal-title":"J Clin Oncol"},{"key":"10.1016\/j.ctro.2026.101156_b0085","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.radonc.2019.07.025","article-title":"(18)F-FDG-PET\/CT-based treatment planning for definitive (chemo)radiotherapy in patients with head and neck squamous cell carcinoma improves regional control and survival","volume":"142","author":"van den Bosch","year":"2020","journal-title":"Radiother Oncol"},{"key":"10.1016\/j.ctro.2026.101156_b0090","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.radonc.2013.06.044","article-title":"Reduction of the dose to the elective neck in head and neck squamous cell carcinoma, a randomized clinical trial using intensity modulated radiotherapy (IMRT). Dosimetrical analysis and effect on acute toxicity","volume":"109","author":"Nuyts","year":"2013","journal-title":"Radiother Oncol"},{"key":"10.1016\/j.ctro.2026.101156_b0095","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.radonc.2019.01.018","article-title":"Selection of lymph node target volumes for definitive head and neck radiation therapy: a 2019 Update","volume":"134","author":"Biau","year":"2019","journal-title":"Radiother Oncol"},{"key":"10.1016\/j.ctro.2026.101156_b0100","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.radonc.2015.07.041","article-title":"CT-based delineation of organs at risk in the head and neck region: DAHANCA, EORTC, GORTEC, HKNPCSG, NCIC CTG, NCRI, NRG Oncology and TROG consensus guidelines","volume":"117","author":"Brouwer","year":"2015","journal-title":"Radiother Oncol"},{"key":"10.1016\/j.ctro.2026.101156_b0105","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/j.radonc.2011.05.015","article-title":"Delineation of organs at risk involved in swallowing for radiotherapy treatment planning","volume":"101","author":"Christianen","year":"2011","journal-title":"Radiother Oncol"},{"key":"10.1016\/j.ctro.2026.101156_b0110","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.radonc.2014.09.013","article-title":"Development of a multivariable normal tissue complication probability (NTCP) model for tube feeding dependence after curative radiotherapy\/chemo-radiotherapy in head and neck cancer","volume":"113","author":"Wopken","year":"2014","journal-title":"Radiother Oncol"},{"key":"10.1016\/j.ctro.2026.101156_b0115","doi-asserted-by":"crossref","first-page":"354","DOI":"10.14338\/IJPT-20-00089.1","article-title":"National protocol for model-based selection for proton therapy in head and neck cancer","volume":"8","author":"Langendijk","year":"2021","journal-title":"Int J Part Ther"},{"key":"10.1016\/j.ctro.2026.101156_b0120","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.radonc.2011.12.027","article-title":"Dose-response analysis of acute oral mucositis and pharyngeal dysphagia in patients receiving induction chemotherapy followed by concomitant chemo-IMRT for head and neck cancer","volume":"103","author":"Bhide","year":"2012","journal-title":"Radiother Oncol"},{"key":"10.1016\/j.ctro.2026.101156_b0125","doi-asserted-by":"crossref","first-page":"e93","DOI":"10.1016\/j.ijrobp.2010.12.067","article-title":"Chemo-IMRT of oropharyngeal cancer aiming to reduce dysphagia: swallowing organs late complication probabilities and dosimetric correlates","volume":"81","author":"Eisbruch","year":"2011","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"10.1016\/j.ctro.2026.101156_b0130","doi-asserted-by":"crossref","first-page":"620","DOI":"10.3109\/0284186X.2014.892209","article-title":"Radiation-induced trismus in the ARTSCAN head and neck trial","volume":"53","author":"Lindblom","year":"2014","journal-title":"Acta Oncol"},{"key":"10.1016\/j.ctro.2026.101156_b0135","article-title":"Proton versus photon radiotherapy for patients with oropharyngeal cancer in the USA: a multicentre, randomised, open-label, non-inferiority phase 3 trial","author":"Frank","year":"2025","journal-title":"Lancet"},{"key":"10.1016\/j.ctro.2026.101156_b0140","article-title":"High-dose loco-regional pattern of failure after primary radiotherapy in p16 positive and negative head and neck squamous cell carcinoma - a DAHANCA 19 study","volume":"46","author":"Kristensen","year":"2024","journal-title":"Clin Transl Radiat Oncol"},{"key":"10.1016\/j.ctro.2026.101156_b0145","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/s13014-025-02641-8","article-title":"Combined spatial and dosimetric recurrence pattern analysis in head and neck squamous cell carcinoma following postoperative (Chemo)radiotherapy","volume":"20","author":"Schroter","year":"2025","journal-title":"Radiat Oncol"},{"key":"10.1016\/j.ctro.2026.101156_b0150","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1016\/j.ijrobp.2020.03.021","article-title":"Individualized prophylactic neck irradiation in patients with cN0 head and neck cancer based on sentinel lymph node(s) identification: definitive results of a prospective phase 1-2 study","volume":"107","author":"Longton","year":"2020","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"10.1016\/j.ctro.2026.101156_b0155","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.radonc.2020.03.012","article-title":"SPECT\/CT-guided elective nodal irradiation for head and neck cancer is oncologically safe and less toxic: a potentially practice-changing approach","volume":"147","author":"de Veij Mestdagh","year":"2020","journal-title":"Radiother Oncol"},{"key":"10.1016\/j.ctro.2026.101156_b0160","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1016\/j.ijrobp.2020.09.063","article-title":"Prospective phase 2 study of radiation therapy dose and volume de-escalation for elective neck treatment of oropharyngeal and laryngeal cancer","volume":"109","author":"Sher","year":"2021","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"10.1016\/j.ctro.2026.101156_b0165","doi-asserted-by":"crossref","DOI":"10.1016\/j.clon.2025.103873","article-title":"Relationship between elective neck irradiation and severe lymphopenia in patients treated with head and neck chemoradiotherapy","volume":"44","author":"Mickel","year":"2025","journal-title":"Clin Oncol (R Coll Radiol)"},{"key":"10.1016\/j.ctro.2026.101156_b0170","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.radonc.2022.01.003","article-title":"The impact of radiation induced lymphopenia in the prognosis of head and neck cancer: a systematic review and meta-analysis","volume":"168","author":"Dai","year":"2022","journal-title":"Radiother Oncol"}],"container-title":["Clinical and Translational Radiation Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2405630826000510?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2405630826000510?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T03:46:03Z","timestamp":1783395963000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2405630826000510"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":34,"alternative-id":["S2405630826000510"],"URL":"https:\/\/doi.org\/10.1016\/j.ctro.2026.101156","relation":{},"ISSN":["2405-6308"],"issn-type":[{"value":"2405-6308","type":"print"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"De-escalation of elective radiotherapy guided by FDG-PET lowers modeled late swallowing-related toxicity in head and neck cancer","name":"articletitle","label":"Article Title"},{"value":"Clinical and Translational Radiation Oncology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ctro.2026.101156","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Author(s). Published by Elsevier B.V. on behalf of European Society for Radiotherapy and Oncology.","name":"copyright","label":"Copyright"}],"article-number":"101156"}}