Contemporary management of the neck in nasopharyngeal carcinoma

Abstract

Up to 85% of the patients with nasopharyngeal carcinoma present with regional nodal metastasis. Although excellent nodal control is achieved with radiotherapy, a thorough understanding of the current TNM staging criteria and pattern of nodal spread is essential to optimize target delineation and minimize unnecessary irradiation to adjacent normal tissue. Selective nodal irradiation with sparing of the lower neck and submandibular region according to individual nodal risk is now emerging as the preferred treatment option. There has also been continual refinement in staging classification by incorporating relevant adverse nodal features. As for the uncommon occurrence of recurrent nodal metastasis after radiotherapy, surgery remains the standard of care.

Survival in oral and pharyngeal cancers is catching up with laryngeal cancer in the NORDIC countries through a half century

“…Most patients have locally advanced or metastatic cancer for which cisplatin‐based chemotherapy is applied in combination with intensity modulated radiotherapy, or chemotherapy may be applied in adjuvant setting or as an induction chemotherapy 47 . For nodal metastases selected targeted radiation saves adjacent structures 48 . The rapidly increasing oropharyngeal cancer is becoming a major clinical challenge and the predicted relief by HPV vaccination will be gradual with major impact several decades into the future 49–52 .…”

Current Radiotherapy Considerations for Nasopharyngeal Carcinoma

“…By contrast, no cervical node involvement was identified in the following specific areas: within the submandibular gland; the gap between the sternocleidomastoid and splenius muscles in level II; the gap between the sternocleidomastoid and infrahyoid muscles in level IVa; and the gap between the skin and omohyoid muscle in level Vc. Therefore, the NPC-specific delineation of the cervical lymphatics was proposed to improve coverage and reduce unnecessary normal tissue irradiation, which contributes to neck fibrosis and post-radiation hypothyroidism [ 23 ].…”

Distribution of regional lymph lode metastasis in unilateral nasopharyngeal carcinoma and the suggestions for selective prophylactic irradiation with intensity‐modulated radiotherapy

“…Intensity modulated radiotherapy (IMRT) is the primary treatment for nasopharyngeal carcinoma (NPC) 1 . More than 80% of NPC patients have regional lymph node (RLN) metastasis at the time of diagnosis, and approximately 50% have bilateral RLN metastasis 2,3 . Therefore, most international research centers 4–6 recommend that prophylactic whole‐neck irradiation should be performed for any stage.…”

“…1 More than 80% of NPC patients have regional lymph node (RLN) metastasis at the time of diagnosis, and approximately 50% have bilateral RLN metastasis. 2,3 Therefore, most international research centers [4][5][6] recommend that prophylactic whole-neck irradiation should be performed for any stage. However, there are few studies on how to carry out selective prophylactic irradiation of bilateral neck in unilateral NPC, which was confined to the one side of the nasopharynx by fiberoptic endoscopy and magnetic resonance imaging (MRI).…”