Are neck nodal volumes drawn on CT slices covered by standard three-field technique?

Sanguineti, Giuseppe; Culp, Laura; Endres, Eugene J.; Bayouth, John E.

doi:10.1016/j.ijrobp.2003.11.025

Cited by 20 publications

(15 citation statements)

References 19 publications

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“…Optimized tumor target coverage and dose delivery from IMRT may prevent marginal recurrences seen with traditional 2-dimensional opposed lateral fields. 33 Further investigation of the pattern of failure for our series has shown that predominantly failure is in the GTV, with no marginal misses, indicating that our practice of target volume delineation has been adequate. 22,31,34 We continue to recommend the use of optimal image modalities (eg, MRI, PET-CT, or contrast-enhanced CT scans) to assist the delineation of the tumor targets.…”

Section: Discussionmentioning

confidence: 59%

Intensity‐modulated chemoradiation for treatment of stage III and IV oropharyngeal carcinoma

Huang

Xia

Chuang

et al. 2008

Cancer

124

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BACKGROUND.Treatment outcomes for stage III and IV oropharyngeal carcinoma treated with intensity‐modulated radiotherapy (IMRT) and concurrent chemotherapy without prior surgical resection were reviewed.METHODS.Between April 2000 and September 2004, 71 patients underwent IMRT concurrent with chemotherapy without prior surgical resection for stage III and IV oropharyngeal carcinoma. Chemotherapy was platinum based. The gross tumor volume (GTV) received 70 Gy in 2.12 Gy per fraction. The high‐risk clinical tumor volume (CTV) received 59.4 Gy in 1.80 Gy per fraction, and the low‐risk CTV received 54 Gy in 1.64 Gy per fraction.RESULTS.With a median follow‐up of 33 months, the 3‐year local, regional, and locoregional progression‐free probabilities were 94%, 94%, and 90%, respectively. The 3‐year overall survival estimate was 83%. Locoregional failures occurred in the GTV in 7 patients. Acute grade 3 or 4 toxicity developed in 35 patients. A feeding gastrostomy was placed in 25 patients. Late xerostomia was grade 0 in 16 patients, grade 1 in 31 patients, and grade 2 in 24 patients at last follow‐up. No patients experienced grade 3 or 4 late toxicity, except for 1 who developed osteoradionecrosis of the mandible.CONCLUSIONS.Excellent local and regional control was achieved with IMRT and concurrent chemotherapy without prior surgical resection in the treatment of stage III and IV oropharyngeal carcinoma. Significant sparing of the parotid glands and other critical normal tissues was possible using IMRT with moderate acute toxicities and minimal severe late effects. Cancer 2008. © 2008 American Cancer Society.

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Section: Discussionmentioning

confidence: 59%

Intensity‐modulated chemoradiation for treatment of stage III and IV oropharyngeal carcinoma

Huang

Xia

Chuang

et al. 2008

Cancer

124

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“…As previously discussed [17] the advantages to skip level V are mainly surgical ones though one cannot exclude that also beam-path toxicities such as alopecia in the occipital region could be impacted as well [18,19]. …”

Section: Discussionmentioning

confidence: 99%

HPV-related oropharyngeal carcinoma with Overt Level II and/or III metastases at presentation: The risk of subclinical disease in ipsilateral levels IB, IV and V

et al. 2013

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Background To assess the risk of subclinical neck nodal involvement of levels IB, IV and V for early T-stage, node positive, human papilloma virus (HPV)-related oropharyngeal carcinoma. Material and methods We retrospectively identified the patients with clinically positive and un-violated neck that underwent upfront ipsilateral neck dissection for HPV-related oropharyngeal cancer between 1998 and 2010. From the pathology report we extracted the prevalence rate of involvement of each selected level and then estimated the risk that a level that does not contain any node larger than 10 mm at computed tomography (CT) harbors subclinical disease. Predictors of involvement were investigated as well. Results Ninety-one patients were analyzed. The risk of subclinical disease in both levels IB and V is < 5%, while it is 6.5% (95% CI 3.1–9.9%) for level IV. Level IB subclinical involvement slightly exceeds 5% when 2 + ipsilateral levels besides IB are involved. The risk of occult disease in level IV tends to be < 5% when level III is not involved. Conclusion These data support the exclusion from the elective nodal volume of level V and level IB but when 2 + other levels are involved. Level IV might also be spared when level III is negative. Clinical implementation within a prospective study is justified.

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“…It previously was shown that with conformal radiotherapy, only the posterior aspect of Level IB is within the initial standard fields for oropharyngeal cancer (18). Submandibular nodes usually are located on the bony and cutaneous surfaces of the submandibular gland (19).…”

Section: Discussionmentioning

confidence: 99%

“…Perhaps this explains in part why, in clinical practice, Level V often is included in the low-dose CTV: Radiation Therapy Oncology Group 0022 recommended Level V coverage in all patients with positive jugular lymph nodes (15), and Gregoire et al (16) recommended its inclusion in patients with N2b or higher neck disease. However, as in the case of Level IB, one may argue that the apex of Level V as defined by Hamoir et al (23) does not need to be included because it rarely contains lymph nodes and was not covered by traditional conformal fields (18).…”

Section: Discussionmentioning

confidence: 99%

Defining the Risk of Involvement for Each Neck Nodal Level in Patients With Early T-Stage Node-Positive Oropharyngeal Carcinoma

Sanguineti¹,

Califano²,

Stafford³

et al. 2009

International Journal of Radiation Oncology*Biology*Physics

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Are neck nodal volumes drawn on CT slices covered by standard three-field technique?

Cited by 20 publications

References 19 publications

Intensity‐modulated chemoradiation for treatment of stage III and IV oropharyngeal carcinoma

Intensity‐modulated chemoradiation for treatment of stage III and IV oropharyngeal carcinoma

HPV-related oropharyngeal carcinoma with Overt Level II and/or III metastases at presentation: The risk of subclinical disease in ipsilateral levels IB, IV and V

Defining the Risk of Involvement for Each Neck Nodal Level in Patients With Early T-Stage Node-Positive Oropharyngeal Carcinoma

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