Abstract
PurposeTo explore the feasibility of contralateral lower neck sparing radiotherapy for patients with stage N1 nasopharyngeal carcinoma (NPC) by analyzing long-term survival outcomes and late toxicities.MethodsData of patients with stage N1 NPC who were treated with contralateral lower neck sparing radiotherapy between January 2013 and December 2015 were analyzed. These patients were all staged by magnetic resonance imaging (MRI), and all received irradiation to the upper neck (levels II, III, and Va) bilaterally along with ipsilateral levels IV and Vb, without irradiation of the contralateral lower neck. Treatment outcomes, regional failure patterns, and late toxicities were examined.ResultsA total of 275 eligible patients with stage N1 NPC were included in the present study. The median follow-up period was 62 months (range, 3–93 months). The 5-year overall survival (OS), distant metastasis-free survival (DMFS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), locoregional recurrence-free survival (LRRFS), and progression-free survival (PFS) rates were 90.5, 91.3, 94.7, 95.3, 91.2, and 81.7%, respectively. A total of 13 patients (4.7%) developed regional recurrence, all of which occurred in the field and not out of the field. Among 254 patients with available data on late toxicities, the most common late toxicity was xerostomia. No late injuries occurred in the carotid arteries, brachial plexus, or spinal cord. In addition to one case (0.4%) of neck fibrosis and three cases (1.2%) of hearing loss, there were no other grade 3–4 late toxicities observed.ConclusionsContralateral lower neck sparing radiotherapy would be safe and feasible for patients with stage N1 NPC, with the potential to improve the long-term quality of life of patients.
Highlights
Nasopharyngeal carcinoma (NPC) is a type of epithelial head and neck tumor with definite geographical distribution characteristics and is especially prevalent in East and Southeast Asia [1]
Our team previously reported a study in which we found that only 1.4% of patients with stage N0–1 NPC experienced out-of-field lymph node recurrence when levels IV and Vb was excluded from the irradiation of node-negative necks [18]
Inclusion criteria were as follows: [1] newly diagnosed and pathologically proven NPC; [2] undergoing magnetic resonance imaging (MRI) scans of the nasopharynx and neck at diagnosis; [3] T1–4N1M0 disease according to the 8th edition of the American Joint Committee on Cancer (AJCC) Staging Manual; [4] no other concomitant malignant tumors; [5] receiving contralateral lower neck sparing radiotherapy with intensity-modulated radiotherapy (IMRT) technique, that is, bilateral upper neck along with levels IV and Vb on the side with cervical lymph node involvement were irradiated, while the contralateral lower neck was not irradiated; [6] data of the target delineation were available
Summary
Nasopharyngeal carcinoma (NPC) is a type of epithelial head and neck tumor with definite geographical distribution characteristics and is especially prevalent in East and Southeast Asia [1]. Many studies [13,14,15,16,17] have focused on the efficacy of prophylactic upper neck radiotherapy in patients with stage N0 NPC or with only retropharyngeal lymph node metastasis. Studies on whether contralateral lower neck sparing radiotherapy would be safe for patients with stage N1 NPC are still scarce. Our team previously reported a study in which we found that only 1.4% of patients with stage N0–1 NPC experienced out-of-field lymph node recurrence when levels IV and Vb was excluded from the irradiation of node-negative necks [18]. This study provided some evidence to support the radiotherapy approach of sparing the lower neck, it had some limitations. Late toxicities associated with neck irradiation received inadequate attention
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