Comparative study on prophylactic irradiation to the whole neck and to the upper neck for patients with neck lymph node-negative nasopharyngeal carcinoma

Zeng, Lei; Sun, Xue Ming; Chen, Chun Yan; Han, Fei; Huang, Ying; Xiao, Wei; Liu, Shuai; Tian, Yun; Deng, Xiao Wu; Lu, Tai Xiang

doi:10.1002/hed.23359

Cited by 20 publications

(23 citation statements)

References 30 publications

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“…One study was a randomized controlled trial, 13 and the other four were retrospective two-arm studies. 14 - 17 The randomized controlled trial had an adequate sample, and contamination and co-interventions were controlled, which would be difficult in a retrospective study. All studies had measurable outcomes with clinically significant results.…”

Section: Resultsmentioning

confidence: 99%

“…Nodal relapse may occur in the lower neck if there is insufficient coverage to this area, which may harbor microscopic disease. In three included studies, five of seven nodal relapses in the UNI arm occurred at in-field sites, 14 , 15 , 17 whereas another study reported only 16 patients (2.7%) of the total cohort with relapse in the elective nodal area; the study also reported relapse in 13 patients (2.1%) in the out-of-field area, and relapse in two patients (6.5%) in both the in-field and out-of-field areas. 16 The results show that coverage was adequate with UNI because treatment failures occurred mostly at in-field sites.…”

Section: Discussionmentioning

confidence: 99%

“…In the studies included in this review, two studies showed no significant difference in the rates of acute and late effects, except more patients had lower neck dermatitis, skin atrophy, and lung apex fibrosis in the WNI group. 13 , 14 One study reported that three patients had cranial neuropathy and one patient had unilateral laryngeal nerve palsy in the WNI group. 15 …”

Section: Discussionmentioning

confidence: 99%

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Evidence on Effectiveness of Upper Neck Irradiation Versus Whole Neck Irradiation as Elective Neck Irradiation in Node-Negative Nasopharyngeal Cancer: A Meta-Analysis

Mejia

Dizon³

2018

JGO

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PurposeNasopharyngeal carcinoma (NPC) is a central tumor with a rich lymphatic network and a propensity for bilateral cervical lymph node metastasis. There is an orderly pattern of lymph node involvement in NPC. There is no current standard for prophylactic neck irradiation in node-negative or limited retropharyngeal (RP) node–positive NPC. This study aims to synthesize the current evidence on upper neck irradiation (UNI) versus whole neck irradiation (WNI) as prophylactic neck irradiation in node-negative or limited RP node–positive NPC.Materials and MethodsA search of relevant articles was done from 2000 to October 2015. Critical appraisal and meta-analysis of the eligible studies were undertaken to assess the effectiveness of UNI versus WNI as prophylactic neck irradiation in node-negative or limited involved RP node NPC.ResultsOnly one randomized controlled trial investigated the use of prophylactic UNI versus WNI and showed no confirmed nodal relapse in both arms. Pooled analysis of four retrospective studies showed no significant difference in nodal recurrence, whether in-field or out-of-field recurrence. There was also no significant difference in terms of 5-year distant metastasis–free and overall survival.ConclusionIn node-negative or limited RP node–positive NPC, the current evidence shows the possibility of treating only the upper neck (levels II, III, and VA) without compromising nodal control, distant metastasis, and overall survival. As a result of the scarcity of data, more randomized clinical trials are warranted in this subset of patients.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Evidence on Effectiveness of Upper Neck Irradiation Versus Whole Neck Irradiation as Elective Neck Irradiation in Node-Negative Nasopharyngeal Cancer: A Meta-Analysis

Mejia

Dizon³

2018

JGO

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“…Isolated neck failure occurs in less than 10% of patients with contemporary treatment [ 119 ]. In the unlikely event of occurrence, surgical neck dissection is the preferred choice for salvage, and it is even effective for deep retropharyngeal nodal metastasis [ 120 ].…”

Section: Treatmentmentioning

confidence: 99%

Progression of understanding for the role of Epstein-Barr virus and management of nasopharyngeal carcinoma

Nakanishi

Wakisaka

Kondo

et al. 2017

Cancer Metastasis Rev

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Nasopharyngeal carcinoma (NPC) is very common in southern China and Southeast Asia. In regions where NPC is endemic, undifferentiated subtypes constitute most cases and are invariably associated with Epstein-Barr virus (EBV) infection, whereas the differentiated subtype is more common in other parts of the world. Undifferentiated NPC is a unique malignancy with regard to its epidemiology, etiology, and clinical presentation. Clinically, NPC is highly invasive and metastatic, but sensitive to both chemotherapy and radiotherapy (RT). Overall prognosis has dramatically improved over the past three decades because of advances in management, including the improvement of RT technology, the broader application of chemotherapy, and more accurate disease staging. Despite the excellent local control with modern RT, distant failure remains a challenging problem. Advances in molecular technology have helped to elucidate the molecular pathogenesis of NPC. This article reviews the contribution of EBV gene products to NPC pathogenesis and the current management of NPC.

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“…They concluded that ENI by conventional technique to 50 to 56 Gy confined to RPN and levels II, III, and Va was safe for N0 NPC. The retrospective study by Zeng et al [ 18 ] showed that the 5-year OS, nodal recurrence-free survival, and distant metastasis-free survival rates of the upper neck group and the whole neck group were 93.6% vs. 90.9% (p = 0.553), 99.4% vs. 99.0% (p = 0.278), and 98.8% vs. 94.9% (p = 0.128), respectively in 270 patients with N0 NPC who had undergone IMRT. A total of 3 neck recurrences were found, including 2 from the whole neck group and 1 from the upper neck group.…”

Section: Discussionmentioning

confidence: 99%

Patterns of failure after the reduced volume approach for elective nodal irradiation in nasopharyngeal carcinoma

Seol

Lee

2016

Radiat Oncol J

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PurposeTo evaluate the patterns of nodal failure after radiotherapy (RT) with the reduced volume approach for elective neck nodal irradiation (ENI) in nasopharyngeal carcinoma (NPC).Materials and MethodsFifty-six NPC patients who underwent definitive chemoradiotherapy with the reduced volume approach for ENI were reviewed. The ENI included retropharyngeal and level II lymph nodes, and only encompassed the echelon inferior to the involved level to eliminate the entire neck irradiation. Patients received either moderate hypofractionated intensity-modulated RT for a total of 72.6 Gy (49.5 Gy to elective nodal areas) or a conventional fractionated three-dimensional conformal RT for a total of 68.4–72 Gy (39.6–45 Gy to elective nodal areas). Patterns of failure, locoregional control, and survival were analyzed.ResultsThe median follow-up was 38 months (range, 3 to 80 months). The out-of-field nodal failure when omitting ENI was none. Three patients developed neck recurrences (one in-field recurrence in the 72.6 Gy irradiated nodal area and two in the elective irradiated region of 39.6 Gy). Overall disease failure at any site developed in 11 patients (19.6%). Among these, there were six local failures (10.7%), three regional failures (5.4%), and five distant metastases (8.9%). The 3-year locoregional control rate was 87.1%, and the distant failure-free rate was 90.4%; disease-free survival and overall survival at 3 years was 80% and 86.8%, respectively.ConclusionNo patient developed nodal failure in the omitted ENI site. Our investigation has demonstrated that the reduced volume approach for ENI appears to be a safe treatment approach in NPC.

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Comparative study on prophylactic irradiation to the whole neck and to the upper neck for patients with neck lymph node-negative nasopharyngeal carcinoma

Abstract: Prophylactic irradiation to the upper neck (levels II, III, and VA) may be feasible for patients with neck lymph node-negative NPC.

Cited by 20 publications

References 30 publications

Evidence on Effectiveness of Upper Neck Irradiation Versus Whole Neck Irradiation as Elective Neck Irradiation in Node-Negative Nasopharyngeal Cancer: A Meta-Analysis

Evidence on Effectiveness of Upper Neck Irradiation Versus Whole Neck Irradiation as Elective Neck Irradiation in Node-Negative Nasopharyngeal Cancer: A Meta-Analysis

Progression of understanding for the role of Epstein-Barr virus and management of nasopharyngeal carcinoma

Patterns of failure after the reduced volume approach for elective nodal irradiation in nasopharyngeal carcinoma

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