Patterns of lymph node metastasis from nasopharyngeal carcinoma based on the 2013 updated consensus guidelines for neck node levels

Wang, Xiaoshen; Hu, Chaosu; Ying, Hongmei; He, Xianghuo; Zhu, Guoding; Kong, Lin; Ding, Jiale

doi:10.1016/j.radonc.2015.02.017

Cited by 84 publications

(67 citation statements)

References 24 publications

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“…Previous studies reported that 13.6% [4] and 15% [10] of patients with NPC had no lymph node metastasis, similar to the results of the present study (13.9%). In the cohort examined in the present study, tumor stage and treatment-related factors were well balanced between the small and large ENLN groups, and univariate analysis revealed that the 4-year RRFS rate was significantly higher in the small ENLN group than in the large ENLN group ( P = 0.049).…”

Section: Discussionsupporting

confidence: 92%

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Clinical treatment considerations in the intensity-modulated radiotherapy era for patients with N0-category nasopharyngeal carcinoma and enlarged neck lymph nodes

et al. 2017

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BackgroundNasopharyngeal carcinoma (NPC) shows a high proportion of lymph node metastasis, and treatment guidelines have been developed for positive nodes. However, no irradiation guidelines have been proposed for patients with enlarged neck lymph nodes (ENLNs) that do not meet the radiological criteria of 10 mm in diameter for positive lymph nodes. This study aimed to determine the prognostic value and radiation dose for ENLNs in N0-category NPC patients treated with intensity-modulated radiotherapy (IMRT).MethodsWe reviewed the medical data of 251 patients with non-metastatic, N0-category NPC treated with IMRT. Receiver operating characteristic curves were used to calculate the cut-off value of the ENLN diameter for the prediction of disease failure. The biological equivalent dose (BED) for ENLNs was calculated. Patient survival was compared between the small and large ENLN groups. Independent prognostic factors were identified using the Cox proportional hazards model.ResultsThe estimated 4-year regional relapse-free survival rate was higher in patients with ENLNs ≥5.5 mm than in those with ENLNs <5.5 mm (100% vs. 98.8%, P = 0.049), whereas disease-free, overall, and distant metastasis-free survival rates were similar between the two groups. After adjusting for various factors, ENLN diameter was not identified as an independent prognostic factor (P > 0.05 for all survival rates). In the subgroup analysis, patients receiving BED ≥72 Gy had a similar prognosis as patients receiving BED <72 Gy in both the small and large ENLN groups. The multivariate analysis also confirmed that BED ≥72 Gy was not associated with significantly improved prognosis in patients with N0-category NPC.ConclusionsA BED of 72 Gy to ENLNs is considerably sufficient to provide a clinical benefit to patients with N0-category NPC. Prospective studies are warranted to validate the findings in the present study.

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Section: Discussionsupporting

confidence: 92%

“…NPC has a high proportion of LN metastasis (86.4%) [4], and the NCCN guidelines recommend a prescribed dose of 66–70 Gy to treat positive LNs. However, no irradiation guidelines have been proposed for patients with enlarged neck LNs (ENLNs) that do not meet the radiological criteria of 10 mm in diameter for positive LNs [5].…”

Section: Introductionmentioning

confidence: 99%

Clinical treatment considerations in the intensity-modulated radiotherapy era for patients with N0-category nasopharyngeal carcinoma and enlarged neck lymph nodes

et al. 2017

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“…It has been reported that the incidence of PLNM was 0.6 % ~ 3.0 % in whole NPC patients [3–7, 16]. And similarly, the incidence of PLNM was 1.8 % in whole patients and was 3.3 % in N2-3 NPC patients in this study.…”

Section: Discussionsupporting

confidence: 74%

“…13.6 %, p < 0.001). 3.1–4.3 % cases with level Ib involvement has been reported in previous study and all patients were simultaneously accompanied with level II lymphadenopathy [3, 16]. Wang reported 1.8 % level Vc involvement in N-positive NPC patients.…”

Section: Discussionmentioning

confidence: 72%

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High-risk factors of parotid lymph node metastasis in nasopharyngeal carcinoma: a case-control study

et al. 2016

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BackgroundAlthough parotid-sparing IMRT decreased the dose distribution of parotid, parotid region recurrence has been reported. Prophylactic irradiation in parotid area would be necessary in patients with high risk of parotid lymph node metastasis (PLNM). This study was to detect the high-risk factors of PLNM in nasopharyngeal carcinoma.MethodsThis was a 1:2 case-control study. All patients in this study were newly diagnosed NPC with N2-3 classification from January 2005 to December 2012. Cases were 22 sides with ipsilateral PLNM. Controls were 44 patients who were randomly selected from N2-3 disease in database.Results20/1096 (1.82 %) NPC patients were found PLNM. Sum of the longest diameter for multiple lymph nodes (SLD) in level II was larger in case group than that in control group (6.0 cm vs. 3.6 cm, p = 0.003). Level II lymph node necrosis, level Va/b involvement, and rare neck areas involvement were more common in case group (p = 0.016, p = 0.034, and p < 0.001, respectively). RPN, level III, and level IV metastases showed no significant difference between the two groups. Multivariate analysis in logistic regression showed that only SLD ≥5 cm in II area (OR = 4.11, p = 0.030) and rare neck areas involvement (OR = 3.95, p = 0.045) were associated with PLNM in NPC patients.ConclusionsPLNM was an uncommon event in NPC patients. SLD ≥5 cm in level II and involvement in rare-neck areas may be potentially high-risk factors for PLNM. Sparing parotid in IMRT was not recommended for NPC patients with high risks of PLNM.

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Nasopharyngeal Carcinoma in Nonendemic Populations

McDowell

Lim

Corry

2017

Textbook of Uncommon Cancer

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Patterns of lymph node metastasis from nasopharyngeal carcinoma based on the 2013 updated consensus guidelines for neck node levels

Cited by 84 publications

References 24 publications

Clinical treatment considerations in the intensity-modulated radiotherapy era for patients with N0-category nasopharyngeal carcinoma and enlarged neck lymph nodes

Clinical treatment considerations in the intensity-modulated radiotherapy era for patients with N0-category nasopharyngeal carcinoma and enlarged neck lymph nodes

High-risk factors of parotid lymph node metastasis in nasopharyngeal carcinoma: a case-control study

Nasopharyngeal Carcinoma in Nonendemic Populations

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