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

Weixu Hu,Guopei Zhu,Xiaoshen Wang,Chaosu Hu,Xiyin Guan

doi:10.1186/1748-717x-8-230

Weixu Hu, Guopei Zhu + Show 3 more

Open Access

https://doi.org/10.1186/1748-717x-8-230

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Journal: Radiation Oncology	Publication Date: Oct 4, 2013
Citations: 39	License type: cc-by

Affiliation: Fudan University Shanghai Cancer Center

Abstract

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.

Highlights

Nasopharyngeal carcinoma (NPC) is a highly infiltrative tumor and is prone to cervical lymph node metastasis because of the rich lymphatic network in the nasopharynx [1,2,3]
Univariate analysis suggested that T classification was the only significant prognostic factor for overall survival, and age was significantly associated with progress-free survival (PFS)
Multivariate analyses indicated that age was a predictor for overall survival

Summary

Introduction

Nasopharyngeal carcinoma (NPC) is a highly infiltrative tumor and is prone to cervical lymph node metastasis because of the rich lymphatic network in the nasopharynx [1,2,3]. Irradiation treatment of the entire cervical lymph nodal drainage region has been considered a necessity. Some studies proposed that routine irradiation to the retropharyngeal area, levels II–V and the supraclavicular lymph nodal areas were needed regardless of the nodal metastasis status [4,5]. Tang et al [6] reported that there was no statistical difference in risk for regional recurrence neck, including levels IV and VB and supraclavicular regions in patients with positive unilateral upper cervical lymph node and explored the feasibility of reducing the irradiation range in N1 patients

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Conclusion