Effectiveness of prophylactic retropharyngeal lymph node irradiation in patients with locally advanced head and neck cancer

Abstract

Background The aim of the study is to assess the effectiveness of intensity-modulated radiotherapy (IMRT) or image-guided radiotherapy (IGRT) for the prevention of retropharyngeal nodal recurrences in locally advanced head and neck cancer. Methods A retrospective review of 76 patients with head and neck cancer undergoing concurrent chemoradiation or postoperative radiotherapy with IMRT or IGRT who were at risk for retropharyngeal nodal recurrences because of anatomic site (hypopharynx, nasopharynx, oropharynx) and/or the presence of nodal metastases was undertaken. The prevalence of retropharyngeal nodal recurrences was assessed on follow-up positron emission tomography (PET)-CT scans. Results At a median follow-up of 22 months (4–53 months), no patient developed retropharyngeal nodal recurrences. Conclusion Prophylactic irradiation of retropharyngeal lymph nodes with IMRT or IGRT provides effective regional control for individuals at risk for recurrence in these nodes.

Should PET/CT be implemented in the routine imaging work-up of locally advanced head and neck squamous cell carcinoma? A prospective analysis

“…Recently, the potential usefulness of FDG PET for detecting metastatic retropharyngeal lymph nodes (RPLN) has been reported. In addition, RPLN status has a major impact on prognosis and clinical management of oropharyngeal and hypopharyngeal carcinomas [20].…”

Clinical outcomes after local field conformal reirradiation of patients with retropharyngeal nodal metastasis

“…Radiotherapy (RT) is often used to target retropharyngeal nodes as definitive treatment for gross disease involvement or as a prophylactic measure in head and neck sites with predilection for retropharyngeal nodal metastases. Elective irradiation to retropharyngeal nodal basins in patients with high‐risk primary sites result in exceptional locoregional control . Intensity‐modulated radiotherapy (IMRT) allows for the use of a simultaneous integrated boost technique with more selective and precise dose delivery to different organs and requires delineation of retropharyngeal nodes as a clinical target.…”

Feasibility of Tomotherapy-Based Image-Guided Radiotherapy to Reduce Aspiration Risk in Patients with Non-Laryngeal and Non-Pharyngeal Head and Neck Cancer

“…Figure 1 and 2 illustrated the ability of IGRT to spare the larynx and pharynx from a high radiation dose, though the involved adjacent cervical lymph nodes were treated to a curative dose of radiation. Nguyen et al [13] recently reported excellent regional control in head and neck cancer patients treated with WF-IGRT in the presence of cervical lymph nodes. Only one out of 76 patients with either unilateral or bilateral cervical lymph nodes developed regional recurrences.…”

“…Thus, WF-IGRT, by virtue of its laryngeal and pharyngeal muscle sparing along with its decreased aspiration rate may be the technique of choice for non-hypopharyngeal and non-laryngeal head and neck cancer [8]. The additional advantage of WF-IGRT is the excellent regional control in the presence of cervical lymph nodes because of the delivery of high dose to these structures in the face of laryngeal and pharyngeal muscle sparing [13].…”