Study of the medial group retropharyngeal node metastasis from nasopharyngeal carcinoma based on 3100 newly diagnosed cases

Wang, Xiao Shen; Yan, Chao; Hu, Chao; Ying, Hongmei; He, Xi; Zhou, Zheng; Ding, Jian

doi:10.1016/j.oraloncology.2014.08.007

Cited by 29 publications

(38 citation statements)

References 26 publications

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“…Level VII: There were 2012 cases (75.1%) with level VIIa nodal metastasis, but only six (0.2%) were located at the medial group, and were always accompanied with the lateral group lymphadenopathy. Details about the medial group lymphadenopathy were published elsewhere [24]. 178 (6.6%) cases had nodal disease in level VIIb.…”

Section: Incidence and Distribution Of Nodal Metastasismentioning

confidence: 99%

Patterns of lymph node metastasis from nasopharyngeal carcinoma based on the 2013 updated consensus guidelines for neck node levels

Wang

Ying

et al. 2015

Radiotherapy and Oncology

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Section: Incidence and Distribution Of Nodal Metastasismentioning

confidence: 99%

Patterns of lymph node metastasis from nasopharyngeal carcinoma based on the 2013 updated consensus guidelines for neck node levels

Wang

Ying

et al. 2015

Radiotherapy and Oncology

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“…These protocols clearly defined the CTV as including the RLNs from the base of the skull to the cranial edge of the hyoid [13][14][15]. Several studies have shown that in almost all cases in which the RLNs are at risk, only the lateral RLNs are at substantial risk [2][3][4]. Consequently, some researchers have proposed selective delineation of the medial group [1].…”

Section: Discussionmentioning

confidence: 99%

“…Yi et al [17] reported their IMRT experience in 376 NPC patients; they delineated the CTV at 1.0 cm -1.5 cm below the GTV or the cranial edge of C1 if the tumour was confined to the parietal wall and excluded the medial RLNs to reduce the severe early or late radiation damage to the oropharynx. Wang et al [4] showed that 2012 (75.1%) of 3100 patients had RLN metastasis; only 6 metastases (0.2%) were located in the medial group, and they were accompanied by lateral RLN and other node metastases. They have also reported results for IMRT excluding the medial RLNs below one third of the second cervical vertebra (C2) in NPC patients since 2005 and observed no regional failures in the medial group.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown that avoiding exposure of the medial area of the RLN can reduce the dose of radiation received by the pharyngeal constrictor and posterior mucosa of the pharynx, thereby reducing the incidence of mucositis and dysphagia [3][4]. Therefore, in this study, we explored the patterns of RLN metastasis in NPC in 183 patients to provide a basis for the optimization of the CTV delineation of the neck for the treatment of NPC with IMRT.…”

Section: Introductionmentioning

confidence: 99%

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Impact of the Patterns of Retropharyngeal Lymph Node Metastasis on the Clinical Target Volume for the Radiotherapy Treatment of Nasopharyngeal Carcinoma

Tong¹,

Yang²,

Pan³

2019

IJCOCR

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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.

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“…As lymphatic drainage of the nasopharynx is predominantly to the cervical lymph nodes, the first disease sign in many patients is often the appearance of cervical lymphadenopathy. Several studies have shown that approximately 75.4%-86.4% patients have cervical lymph node metastases at diagnosis [ 14 – 16 ]. In the current study, patients in both the T1 and T2 stages had cervical lymph node involvement, although the volume of the primary tumor in these stages is relatively small.…”

Section: Discussionmentioning

confidence: 99%

Tumor Regression and Patterns of Distant Metastasis of T1-T2 Nasopharyngeal Carcinoma with Intensity-Modulated Radiotherapy

2016

PLoS ONE

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PurposeTo study tumor regression and failure patterns in T1-T2 non-metastatic nasopharyngeal carcinoma (NPC) after intensity-modulated radiotherapy (IMRT).MethodsA retrospective analysis of 139 nasopharyngeal carcinoma patients treated with IMRT between January 2005 and December 2010 in our center was performed. According to the AJCC staging system, all primary lesions were attributed to T1 and T2. The prescription doses were 66 Gy at 30 fractions to gross tumor volume of the nasopharynx and the positive neck nodes, 60 Gy to high-risk clinical target volume and 54 Gy to low-risk clinical target volume. Patients staged III, IV A/B or II (lymph node measured 4 cm or more in diameter) received platinum-based chemotherapy.ResultsBy the end of radiotherapy, 7.2% (10/139), 23.7% (33/139), and 9.4% (13/139) of patients had residual lesions in the nasopharynx, cervical lymph nodes and retropharyngeal lymph nodes, respectively. The majority of patients had complete remission within 6 months of radiotherapy completion. Five months after IMRT, three patients with residual tumors in the cervical lymph nodes underwent surgery. Among these patients, two patients had positive pathological findings, and one patient had negative findings. With a median follow-up of 59 months, the 5-year overall survival, local control, regional control and distant metastasis-free rates were 87.8%, 96.7%, 94.9% and 89.1%, respectively. Fifteen patients developed distant metastases, representing the primary failure pattern.ConclusionsMost residual lesions that persisted after IMRT vanished completely in six months. Considering the potential damage to normal structures, clinicians should be cautious when considering the use of boost irradiation after radiotherapy. Distant metastasis was the primary cause of treatment failure, which was significantly higher in N2-3 patients than in N0-1. Additional studies to better understand distant metastases are needed.

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Study of the medial group retropharyngeal node metastasis from nasopharyngeal carcinoma based on 3100 newly diagnosed cases

Cited by 29 publications

References 26 publications

Patterns of lymph node metastasis from nasopharyngeal carcinoma based on the 2013 updated consensus guidelines for neck node levels

Patterns of lymph node metastasis from nasopharyngeal carcinoma based on the 2013 updated consensus guidelines for neck node levels

Impact of the Patterns of Retropharyngeal Lymph Node Metastasis on the Clinical Target Volume for the Radiotherapy Treatment of Nasopharyngeal Carcinoma

Tumor Regression and Patterns of Distant Metastasis of T1-T2 Nasopharyngeal Carcinoma with Intensity-Modulated Radiotherapy

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