Incidence Of Cervical Node Metastasis Research Articles

Lower-Neck Sparing Using Proton Therapy in Patients with Uninvolved Neck Nasopharyngeal Carcinoma: Is It Safe?

Undifferentiated carcinoma of the nasopharynx (NPC) is a rare disease, which usually occurs in the Asian population. Due to its anatomic location, it is characterised by rich lymph node drainage and has a high incidence of cervical node metastasis. However, cervical nodal metastasis commonly involves retropharyngeal nodes and level II nodes, followed by level III nodes. In recent years, innovations in terms of systemic treatments and radiotherapy techniques have improved oncological outcome and treatment-related toxicities. Therefore, there is a growing interest in de-intensification strategies of reducing volumes and treatment-related side effects, especially in patients with NPC with N0–N1-stage disease. Proton therapy could represent a valid alternative to Intensity Modulated Radiotherapy (IMRT) in the management of NPC in this setting. With this Commentary, we aim to explore the feasibility of Intensity Modulated Proton Therapy (IMPT) in upper-neck irradiation of NPC N1-stage disease. We selected an NPC patient with N1 disease and compared the original IMRT plan with the IMPT plan in terms of dosimetric parameters. IMPT offers a minimal dosimetric advantage over IMRT in the bilateral lower-neck sparing. Clinical trials are needed to evaluate the significance of these proposed suggestions and their applicability in non-endemic areas.

Evaluation of incidence of cervical node metastases: A hospital based retrospective study

Evaluation of incidence of cervical node metastases: A hospital based retrospective study

Cervical lymph node metastasis in adenoid cystic carcinoma of oral cavity and oropharynx: A collective international review.

The purpose of this study was to suggest general guidelines in the management of the N0 neck of oral cavity and oropharyngeal adenoid cystic carcinoma (AdCC) in order to improve the survival of these patients and/or reduce the risk of neck recurrences. The incidence of cervical node metastasis at diagnosis of head and neck AdCC is variable, and ranges between 3% and 16%. Metastasis to the cervical lymph nodes of intraoral and oropharyngeal AdCC varies from 2% to 43%, with the lower rates pertaining to palatal AdCC and the higher rates to base of the tongue. Neck node recurrence may happen after treatment in 0-14% of AdCC, is highly dependent on the extent of the treatment and is very rare in patients who have been treated with therapeutic or elective neck dissections, or elective neck irradiation. Lymph node involvement with or without extracapsular extension in AdCC has been shown in most reports to be independently associated with decreased overall and cause-specific survival, probably because lymph node involvement is a risk factor for subsequent distant metastasis. The overall rate of occult neck metastasis in patients with head and neck AdCC ranges from 15% to 44%, but occult neck metastasis from oral cavity and/or oropharynx seems to occur more frequently than from other locations, such as the sinonasal tract and major salivary glands. Nevertheless, the benefit of elective neck dissection (END) in AdCC is not comparable to that of squamous cell carcinoma, because the main cause of failure is not related to neck or local recurrence, but rather, to distant failure. Therefore, END should be considered in patients with a cN0 neck with AdCC in some high risk oral and oropharyngeal locations when postoperative RT is not planned, or the rare AdCC-high grade transformation.

OP125: The features of cervical node metastasis in young adults with oral squamous cell carcinoma

The aim of this study was to analyze the regional metastatic characteristics of oral cancer in younger patients compared with elder patients. Patients with oral squamous cell carcinoma treated in oral and maxillary department of stomatology hospital of Peking University from 2000 to 2011 were entered into the study. They were divided into two age groups: <30 years group (younger group) and ⩾30 years group (elder group). Clinical factors (such as Primary site, growth type, T stage, tumor cell differentiation, incidence of cervical node metastasis, number of unilateral metastatic lymph nodes, Level of metastatic lymph nodes) was compared between the two groups. Under 30-y cut-off, COX regression was applied to analyze the risk factors associated with cervical node metastasis. A total of 1140 cases were enrolled, among them 23 cases were less than 30 years old, and 1117 case ⩾30 years old. Significant difference for the rate of cervical node metastasis was observed between younger group (73.91%) and elder group (41.45%),. The rate of metastatic lymph nodes in level IV–V + I–III was 23.53%(4/17) for younger group compared to 7.36%(34/462) for elder group, and the difference was significant. There was also significant difference for primary site (p0.027), growth type (p0.013), but not T stage (p0.864) and histopathological grading (p0.992) between the two groups. Under 30-y cut-off, multivariable analysis for risk factor associated with cervical node metastasis showed that the p value for age,primary site,growth type,T stage, histopathological grading were 0.004, 0.329, 0.01, 0.000, 0.000, respectively. Age less than 30-y was one of risk factors for cervical node metastasis. Patients younger than 30-y have a greater predisposition to develop regional metastasis in level IV–V, so we cautiously recommend that comprehensive neck treatment is needed for <30-y patients.

Characteristics and risk factors of lymph node metastases in esophageal carcinoma

To investigate the status of lymph node metastases (LNM) of esophageal carcinoma and to identify the risk factors. Clinical data of 308 patients who underwent esophagectomy with three-field lymphadenectomy during January 2006 and December 2010 were reviewed. Characteristics of LNM were studied. The average number of dissected lymph nodes was 35.6 ± 14.5 in 308 patients. There were 197 patients(64%) had LNM. Logistic regression analysis showed that lymphatic vessel invasion(P=0.019) and deep tumor invasion(P<0.001) were risk factors of LNM. The highest LNM site was paratracheal node(25.0%). The incidence of cervical LNM was 14.1% in the middle thoracic carcinoma, higher than that of upper thoracic (7.3%) and lower thoracic (8.3%). Rate of LNM was lower in upper thoracic carcinomas than that in middle or lower ones(P=0.001). No significant difference of LNM was found among upper, middle and lower thoracic carcinoma for cervical or thoracic nodes. Lymphatic vessel invasion(P<0.001) and metastases in paratracheal lymph nodes (P=0.014) were risk factors for cervical LNM. LNM of esophageal carcinoma can be found in both directions vertically and skipped metastasis. Paratracheal lymph nodes involvement is an indicator for cervical lymphadenectomy in thoracic esophageal carcinoma.

Inhibition by streptococcal immunopotentiator OK432 of lymph-node metastasis in hamster cheek-pouch carcinoma with enhancement of tumour necrosis factor-α and interleukin-6 in serum

A well-known metastatic model of human oral cancer employs 9,10-dimethyl-1,2-benzanthracene (DMBA) to induce hamster cheek-pouch carcinoma. Streptococcal immunopotentiator OK432 was studied here for its inhibitory effect on lymph-node metastasis in that model. The intraperitoneal administration of OK432, after excision of cheek-pouch tumours induced by DMBA, resulted in a marked reduction in the incidence of cervical lymph-node metastasis to 7%, a significant decrease beneath the rates observed for control animals not receiving OK432 (40%). OK432 also caused an increased in serum levels of tumour necrosis factor-α and interleukin-6 in tumour-bearing hamsters. These results suggest that the immune response may play an important part in the antimetastatic effects of OK432.

Histologic grading in the clinical evaluation of laryngeal carcinoma.

A histologic grading system based on tumor differentiation was applied in a study of 73 patients with epidermoid carcinoma of the larynx treated at the Milton S. Hershey Medical Center of the Pennsylvania State University from 1971 through September 1977. The supraglottic and subglottic primary tumors were more likely to be poorly differentiated than the glottic carcinomas. In general, the more poorly differentiated the primary tumor, the more advanced was the stage of disease, and the higher the incidence of cervical node metastasis. After treatment, grade 3 patients have a higher incidence of treatment failure and cancer death than grade 1 or 2 patients. The findings suggest that a histologic grading system is an important adjunct to the clinical evaluation.