A randomized clinical trial comparing prophylactic upper versus whole‐neck irradiation in the treatment of patients with node‐negative nasopharyngeal carcinoma

Abstract

BACKGROUND:This study sought to compare the clinical outcomes of upper versus whole-neck prophylactic irradiation in the treatment of patients with node-negative nasopharyngeal carcinoma (NPC). METHODS: Between November 2005 and June 2012, 301 patients with node-negative NPC were randomly assigned to receive primary plus prophylactic upper neck irradiation (UNI, 153 patients) or primary plus whole-neck irradiation (WNI, 148 patients). Patients in both groups received irradiation to the primary tumor and the upper neck nodal regions, and patients in the WNI group also received irradiation to the lower neck. The main endpoint of the study was to compare the lower neck control rate between the 2 groups. RESULTS: With a median follow-up period of 39 months (range, 6-84 months), no patient in either group had a cervical node relapse. The overall survival at 3 years was 89.5% (95% confidence interval [CI] 5 84.1%-95.0%) in the UNI group and 87.4% (95% CI 5 81.4%-93.5%) in the WNI group (hazard ratio [HR] 5 0.866, 95% CI 5 0.41-1.82; P 5.70). The 3-year relapse-free survival rate was 89.8% and 89.3% (95% CI 5 84.2%-95.3% and 83.7%-94.8%, HR 5 0.914, 95% CI 5 0.42-2.00; P 5.82), and the 3-year metastasis-free survival rate was 91.7% and 90.9% (95% CI 5 87.0%-96.5% and 85.7%-96.1%) for the UNI and WNI groups, respectively (HR 5 1.007, 95% CI 5 0.44-2.32; P 5.99). CONCLUSIONS: Prophylactic upper neck irradiation is sufficient for patients with node-negative NPC.

Clinical treatment considerations in the intensity-modulated radiotherapy era for patients with N0-category nasopharyngeal carcinoma and enlarged neck lymph nodes

“…We found that patients receiving a BED ≥72 Gy had a similar prognosis to patients receiving a BED <72 Gy in both the small and large ENLN groups, indicating that a total BED of 72 Gy may be sufficient for the ENLNs. Moreover, Li et al [14] also revealed that the administration of 60 Gy in 30 fractions (BED = 72 Gy) to the suspicious node area did not lead to cervical node relapse, further supporting the results obtained in the present study. This finding should be of great importance to clinicians when devising individualized treatment strategies.…”

“…Many studies have solely focused on the feasibility of omitting irradiation to the lower neck in N0-category NPC [11–14]. However, no studies have investigated the optimal radiation dose for the ENLNs.…”

Long-term Patterns of Regional Failure for Nasopharyngeal Carcinoma following Intensity-Modulated Radiation Therapy

“…For instance, treatment can include high-risk lymph node regions while sparing low-risk lymph node regions. Although a series of studies reported satisfactory regional control and decreased late normal tissue toxicities for NPC patients after IMRT with selective neck irradiation, geographic misses still occur and may cause unexpected regional failures, such as recurrence in parotid nodes 6-10. Therefore, in this study, we retrospectively analyzed the 5-year treatment results of patients with NPC who were treated with IMRT to identify long-term patterns of regional failure.…”

N0-N1 Nasopharyngeal Carcinoma: Can the uninvolved neck be spared?

“…Apart from the retrospective nature, this study has shown that ENI to the whole neck is not necessary in N0 and N1 (RLN+) group. There was no significant difference in 5 year OS of these subgroups (77.9% vs 79.2%) [27].This study has a long term months (range, 6-84 months), no patient in either group had a cervical node relapse [28]. It would be interesting to know the long term results.…”