Correlation analysis of neck node levels in 960 cases of Nasopharyngeal carcinoma (NPC)

Jiang, Chaoyang; Gong, Baolin; Gao, Hui; Zhang, Tao; Li, Zhihui; Wang, Juan; Zhang, Ling

doi:10.1016/j.radonc.2021.05.020

Cited by 14 publications

(18 citation statements)

References 18 publications

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“…Our results regarding the distribution of metastatic lymph nodes in lymphatic drainage regions were consistent with previous findings [ 18 , 20 , 21 ]. Levels IIa, IIb, and VIIa, which are considered the first station nodes, more commonly showed metastasis (metastatic rate exceeded 50%), followed by levels III, V, and IV, which had a > 20% metastatic rate.…”

Section: Discussionsupporting

confidence: 93%

Characteristics of locoregional extension of unilateral nasopharyngeal carcinoma and suggestions for clinical target volume delineation

Zheng

Zhang

et al. 2022

Radiat Oncol

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Background To summarize the characteristics of local invasion and distribution of metastatic lymph nodes in unilateral nasopharyngeal carcinoma (NPC) by magnetic resonance imaging (MRI) to provide references for the optimization of clinical target volume. Methods MRI and clinical data of 176 cases of unilateral NPC admitted to the Hunan Cancer Hospital from January 2019 to December 2019 were collected. Unilateral NPC was defined as a lesion confined to the one side of the nasopharynx and had not exceeded the midline as judged by MRI. Results Ipsilateral levator veli muscle (63.1%, 111/176), tensor veli palatini muscle (55.7%, 98/176), parapharyngeal space (50.0%, 88/176), and prevertebral muscle (43.7%, 77/176) were more likely to be invaded. Contralateral parapharyngeal space and skull base foramina were not invaded. All local invasions presented as continuous invasion from gross lesions and discontinuous invasions were not observed. The overall lymph node metastatic rate was 89.8% (158/176), of which bilateral metastasis accounted for 56.3% (89/158), and ipsilateral metastasis accounted for 88.1% (155/176), which was higher than the contralateral metastatic rate (55.4%, 94/176) (P < 0.001). The most common regions of lymph node metastasis were level IIb (82.4%), VIIa (69.9%), IIa (54.0%), and III (54.0%). Only one patient had skipping lymph node metastasis (0.6%). Conclusion Local invasion of unilateral NPC was characterized by continuous invasion from proximal to distal sites, and lymph node metastasis occurred from the upper to lower neck. Contralateral parapharyngeal space and skull base foramina had a very low probability of invasion, and routine prophylactic radiation may not be necessary.

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Section: Discussionsupporting

confidence: 93%

Characteristics of locoregional extension of unilateral nasopharyngeal carcinoma and suggestions for clinical target volume delineation

Zheng

Zhang

et al. 2022

Radiat Oncol

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“…The 2013 guidelines subdivided level V into level Va, level Vb, and level Vc. We have reported all the correlations for the NNL of NPC in our previous study, and the nodal involvement in level Va was con rmed to have correlation with level IIb, level III, level IVa, level Vb, and PLV region, but have no correlation with level VIIa [10]. Unfortunately, we didn't further elaborate whether the bilateral level Va can be considered as CTVn2 for all NPC patients base on these correlations.…”

Section: Discussionmentioning

confidence: 90%

“…Unfortunately, the PLV region is often overlooked. We have reported the correlations between the PLV region and other NNL, the distribution of metastatic lymph nodes in the PLV region in our previous study [9,10], but what is the boundary of PLV region and how to delineate it is still unclear.…”

Section: Introductionmentioning

confidence: 96%

The proposal of boundary setting for the posterior to level V region and the theoretical feasibility of prophylactic irradiation dose reduction of level Va in nasopharyngeal carcinoma: A retrospective study in a single-center

Jiang¹,

Li²,

Zhang³

et al. 2022

Preprint

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Background: The lymph node involvement in the posterior to level V (PLV) region is mainly observed in nasopharyngeal carcinoma (NPC). Recently, we have reported the distribution of metastatic lymph nodes in the PLV region and there are correlations between the neck node levels (NNL) of NPC, but what is the boundary of the PLV region and how to delineate it remains unclear, and we further to elaborate whether the bilateral level Va should be covered as intermediate-risk clinical target volumes (CTVn2, about 60 Gy equivalent) for all T and N categories based on these correlations.Methods: A total of 1021 consecutive NPC patients with N1-3 stage from January 2012 to December 2020 were reviewed. The lymph node metastasis level of each patient was evaluated according to the updated guidelines proposed in 2013. According to the distribution pattern of lymph node metastasis and the anatomical structure in the PLV region, the boundaries of PLV region was delineated, and whether it is appropriate to cover the bilateral level Va as CTVn2 for all the NPC patients was further discussed.Results: The cranial boundary of PLV region is the caudal border of cricoid cartilage, the caudal boundary is the plane serratus anterior muscle begins to appear, the anterior boundary is the anterior border of trapezius, and the posterior boundary is the convergence of levator scapulae and trapezius. Laterally, the PLV region is limited by the medial edge of trapezius and medially by the lateral surface of levator scapulae. The nodal spread in level Va is based on the lymph node metastasis of level IIb in NPC.Conclusions: The PLV region is a missing NNL of head and neck tumors, especially in NPC. The proposed boundaries of the PLV region can provide a preliminary proposal for the further revision of NNL in head and neck tumors. It is theoretically feasible to reduce the prophylactic irradiation dose of the bilateral level Va in patients with N0 stage or with isolated metastases in level VIIa.

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“…A recent large retrospective study identified all cervical lymph node metastases in 960 patients with node-positive NPC. 8 The nodal levels most frequently involved were VIIa (retropharyngeal nodes) in 86%, IIb in 84%, and IIa in 62%. Level III was involved 47% of the time followed by Va at 25% and IVa at 15%.…”

Section: The Studymentioning

confidence: 95%

PROshot: Weekly Cisplatin Versus Every-3-Weeks Cisplatin, Screening Spine Magnetic Resonance Imaging in Prostate Cancer, Total Neoadjuvant Therapy for Rectal Cancer, and Omitting the Elective Low Neck in Nasopharyngeal Cancer

Dulaney

Dover

2022

Practical Radiation Oncology

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Correlation analysis of neck node levels in 960 cases of Nasopharyngeal carcinoma (NPC)

Cited by 14 publications

References 18 publications

Characteristics of locoregional extension of unilateral nasopharyngeal carcinoma and suggestions for clinical target volume delineation

Characteristics of locoregional extension of unilateral nasopharyngeal carcinoma and suggestions for clinical target volume delineation

The proposal of boundary setting for the posterior to level V region and the theoretical feasibility of prophylactic irradiation dose reduction of level Va in nasopharyngeal carcinoma: A retrospective study in a single-center

PROshot: Weekly Cisplatin Versus Every-3-Weeks Cisplatin, Screening Spine Magnetic Resonance Imaging in Prostate Cancer, Total Neoadjuvant Therapy for Rectal Cancer, and Omitting the Elective Low Neck in Nasopharyngeal Cancer

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