Treatment outcome of nasopharyngeal carcinoma with retropharyngeal lymph nodes metastasis only and the feasibility of elective neck irradiation

Ou, Xiao-Ming; Shen, Chunying; Kong, Lin; Wang, Xiaoshen; Ding, Jiale; Yun-sheng, Gao; Xu, Tianmin; Hu, Chaosu

doi:10.1016/j.oraloncology.2012.04.011

Cited by 22 publications

(32 citation statements)

References 27 publications

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“…Multivariate analysis indicated that elective neck irradiation was not a significant predictor for local or nodal control. However old age was an independent predictor for OS; this result corresponded with previous reports [8,32]. Here, we concluded that elective neck irradiation was not inferior to irradiation of the entire bilateral cervical lymph node area.…”

Section: Discussionsupporting

confidence: 92%

“…Subsequently, Su SF et al [30] reported that in NPC patients with N0 disease, there was no regional disease recurrence even if radiation was applied to the primary tumor and upper neck nodal areas only, while the 5-year regional control, local control and OS rates were 95.6%, 93.4% and 89.8%. Moreover, Yunsheng Gao et al [7] and Xiaomin Ou et al [8] demonstrated that elective neck irradiation to levels II, III and VA was not only suitable for patients with N0 disease but also appropriate for patients with only RLN metastasis; with this treatment, the out-of-field recurrence rates were 0.2% and 0.84%, respectively. Additionally, the authors described high local control rates of 88.6% and 81.4% respectively, while the OS rates were 84.2% and 93.6%.…”

Section: Discussionmentioning

confidence: 99%

“…Lee N et al confirmed that through delivery of high doses up to the target volume without affecting normal structures, IMRT may provide better tumor control [35]. Additionally, Ou et al reported that IMRT displayed the capacity to improve regional control [8]. For NPC, the doses for potential risk sites, such as subclinical cervical areas, were vital for regional control; the consensus opinion is that a dose of 50–60 Gy is necessary [36].…”

Section: Discussionmentioning

confidence: 99%

“…Gao et al [7] reported that elective level II, III and VA irradiation was suitable for NPC without neck lymph node metastasis. A more recent study reported that elective irradiation to levels II, III and VA was not inferior to whole-neck irradiation for NPC patients with retropharyngeal lymph nodes metastasis only [8]. Because no consensus has been reached on the amount of irradiation required for the necks of NPC patients, it is reasonable to question the necessity of irradiation for the bilateral lower neck lymph node levels, including the inferior area of levels V and level IV and the supraclavicular regions in partial N1 patients with only unilateral upper lymph node involvement in the neck.…”

Section: Introductionmentioning

confidence: 99%

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The feasibility of omitting irradiation to the contralateral lower neck in stage N1 nasopharyngeal carcinoma patients

Zhu

Guan

et al. 2013

Radiat Oncol

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PurposeThis study was conducted to analyze the feasibility of omitting irradiation to the contralateral lower neck in stage N1 nasopharyngeal carcinoma (NPC) patients.Materials and methodsFrom July 2008 to January 2012, 52 patients with stage N1 NPC were analyzed. All patients were treated with intensity-modulated radiation therapy (IMRT) and received bilateral upper neck irradiation to levels II, III and VA and ipsilateral lower neck irradiation to levels IV and VB. The contralateral lower neck irradiation was omitted.ResultsThe median follow-up was 29 months (range, 12–52 months). The 3-year overall survival (OS) rate, progress-free survival (PFS), local failure-free (LFS), nodal recurrence-free survival (NFS) and distant metastasis-free survival (DMFS) rates were 92.2%, 94.1%, 94.3%, 98% and 94.1%, respectively. Only one patient developed a neck recurrence in the irradiation field, while no patients experienced out-of-field nodal recurrence. Univariate analysis suggested that T classification was the only significant prognostic factor for overall survival, and age was significantly associated with PFS. Multivariate analyses indicated that age was also a predictor for overall survival. The elective neck irradiation procedure was not a significant predictor for all of the treatment results.ConclusionSelective irradiation to bilateral levels of II, III and VA and unilateral levels of IV and VB, omitted the contralateral lower neck in a proportion of patients with N1 stage NPC was safe and practicable.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The feasibility of omitting irradiation to the contralateral lower neck in stage N1 nasopharyngeal carcinoma patients

Zhu

Guan

et al. 2013

Radiat Oncol

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“…patients was 98.2% and 91.3% respectively. IMRT was employed in this study [41]. The involvement of RLN group has been classified variously across the institutions due to its proximity to the primary location, difficulty in detecting the same with a CECT and the problem of differentiating the local spread vs nodal disease.…”

Section: Literature Reviewmentioning

confidence: 99%

N0-N1 Nasopharyngeal Carcinoma: Can the uninvolved neck be spared?

Laskar

Gurram

Agarwal

2014

J Nasopharyng Carcinoma

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Abstract:Nasopharyngeal cancers (NPC) are characterized by a high predilection for lymph node involvement, mostly orderly. Node negative and N1 NPC comprise around one-third of the cases. Radiotherapy (RT) has been the mainstay of treatment for more than three decades with good results, which has improved further with the use of conformal and precision RT techniques. Despite the large volume of literature on the treatment of NPC, there is a paucity of evidence specifically addressing the volumes and doses to the neck in node negative and N1 disease.With the availability of better imaging modalities and improved RT delivery and verification systems it is possible today to stage patients with NPC with greater certainty and deliver higher doses to the tumour and spare adjacent critical structures better.A systematic review was carried out to evaluate the available evidence addressing the issue of sparing the low risk neck regions in patients with N0 and N1 stage.Available literature reveals that even in the N0 neck, bilateral retropharyngeal group and level II lymph nodes should be considered at risk and cannot be omitted from the radiation portals. The lower neck region is usually at much lower risk of developing metastases in the absence of level II LN involvement and maybe spared.In the N1 patient, contralateral lower neck is at minimal risk of developing disease, and there is a possibility of not treating these regions. Such a practice warrants a stringent follow-up protocol.

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Distribution of regional lymph nodes metastasis in 870 cases of nasopharyngeal carcinoma and the suggestions for individualized elective prophylactic neck irradiation with intensity‐modulated radiotherapy

Wang,

Wu,

et al. 2023

Cancer Medicine

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PurposeTo explore the feasibility of individualized elective prophylactic neck irradiation (iEPNI) for optimizing current approach by investigating metastatic lymph nodes (LNs) distribution in nasopharyngeal carcinoma (NPC).Materials and MethodsRecords of 870 NPC patients without distant metastasis in Hunan Cancer Hospital from January 2019 to December 2019 were reviewed. LNs' locations were identified based on the 2013 guidelines. The intra‐regional lymphatic drainage (IRLD) areas included Station 1st (level VIIa and II), Station 2nd (level III and Va), and Station 3rd (level IV, Vb, and Vc). Other levels were categorized as extra‐regional areas.ResultsAmong the 870 patients, 94.5% cases exhibited LNs metastasis, including unilateral metastasis in 198 patients and bilateral metastasis in 624 patients. In the whole cohort, the most common involved IRLD areas were level IIb (87.1%), VIIa (80.0%), IIa (61.8%), Va (30.6%), IV (21.4%), Vb (8.9%), and Vc (1.1%). Besides, rates of LNs metastasis in Station 1st, 2nd, and 3rd were 94.3%, 61.1%, and 22.9%, respectively. Only four patients (4, 0.5%) revealed skipping metastasis among the three stations.ConclusionsLymph node metastasis follows an organized pattern from Station 1st to 3rd with scarce skipping metastasis. A potential iEPNI strategy of prophylactic neck irradiation to the ipsilateral latter node‐negative station appears promising in NPC patients. Further prospective investigations are warranted to validate the approach.

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Treatment outcome of nasopharyngeal carcinoma with retropharyngeal lymph nodes metastasis only and the feasibility of elective neck irradiation

Cited by 22 publications

References 27 publications

The feasibility of omitting irradiation to the contralateral lower neck in stage N1 nasopharyngeal carcinoma patients

The feasibility of omitting irradiation to the contralateral lower neck in stage N1 nasopharyngeal carcinoma patients

N0-N1 Nasopharyngeal Carcinoma: Can the uninvolved neck be spared?

Distribution of regional lymph nodes metastasis in 870 cases of nasopharyngeal carcinoma and the suggestions for individualized elective prophylactic neck irradiation with intensity‐modulated radiotherapy

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