Abstract
Objective: The aim of this study was to explore the patterns of retropharyngeal lymph node (RLN) metastasis in nasopharyngeal carcinoma (NPC) and their impact on the clinical target volume (CTV) delineation in radiotherapy. Methods: A total of 190 patients with untreated, nonmetastatic NPC received MRI scans of the nasopharynx and neck before treatment. The imaging characteristics of RLN metastasis and their relationships with the staging system were analysed. Results: A total of 121 patients developed RLN metastasis. The incidence rate of RLN metastasis was 63.7%. The RLN metastases of the 121 patients were distributed evenly in the lateral group, and no lymph node metastasis was observed in the medial group. Among the 121 patients, there were 66 cases of unilateral metastasis (54.5%) and 55 cases of bilateral metastasis (45.5%). The central position of the lymph nodes was mainly distributed in the C1 vertebra region. The differences in the RLN metastasis rate between different T stages, N stages and clinical stages were statistically significant (all P<0.01). Conclusion: Medial RLN metastasis is rarely observed in NPC and therefore does not require routine prophylactic irradiation with intensity-modulated radiation therapy (IMRT). This is an important issue for future research.
Highlights
Nasopharyngeal carcinoma (NPC) is rare in many parts of the world, it is endemic in certain regions, especially in Southeast Asia
The retropharyngeal lymph node (RLN) metastasis of the 121 patients was distributed evenly in the lateral group and no lymph node metastasis was seen in the medial group
As the nasopharynx has a well-developed network of lymphatics, NPC has a higher incidence of cervical lymph node metastasis compared with other head and neck cancers
Summary
Nasopharyngeal carcinoma (NPC) is rare in many parts of the world, it is endemic in certain regions, especially in Southeast Asia. Radiotherapy is the mainstay treatment for NPC. IMRT has gradually replaced conventional radiation therapy as the main radiotherapy technology used to treat NPC. The prerequisite for the development and application of IMRT is the correct delineation of the target areas. This allows tumour tissue to receive an accurate dose of radiation while protecting normal tissue. Reducing the clinical target area can reduce the radiation volume, which can relieve adverse radiotherapy reactions [1,2]. To understand the patterns of lymph node metastasis, it is helpful to optimize and standardize the CTV delineation of the neck for NPC
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