Impact of the Patterns of Retropharyngeal Lymph Node Metastasis on the Clinical Target Volume for the Radiotherapy Treatment of Nasopharyngeal Carcinoma
International Journal of Clinical Oncology and Cancer Research
Volume 4, Issue 4, August 2019, Pages: 34-37
Received: Jun. 3, 2019;
Accepted: Jul. 8, 2019;
Published: Oct. 31, 2019
Views 549 Downloads 136
Lihua Tong, Department of Oncology, Nanhai Hospital Affiliated to Southern Medical University, Foshan, China
Wen Yang, Department of Oncology, Nanhai Hospital Affiliated to Southern Medical University, Foshan, China
Xingxi Pan, Department of Oncology, Nanhai Hospital Affiliated to Southern Medical University, Foshan, China
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.
Impact of the Patterns of Retropharyngeal Lymph Node Metastasis on the Clinical Target Volume for the Radiotherapy Treatment of Nasopharyngeal Carcinoma, International Journal of Clinical Oncology and Cancer Research.
Vol. 4, No. 4,
2019, pp. 34-37.
Dirix P, Nuyts S. Evidence-based organ-sparing radiotherapy in head and neck cancer [J]. Lancet Oncology, 2010, 11 (1): 85-91.
Feng F Y, Kim H M, Lyden T H, et al. Intensity-modulated chemoradiotherapy aiming to reduce dysphagia in patients with oropharyngeal cancer: clinical and functional results. [J]. Journal of Clinical Oncology Official Journal of the American Society of Clinical Oncology, 2010, 28 (16): 2732.
Feng F Y, Kim H M, Lyden T H, et al. Intensity-modulated radiotherapy of head and neck cancer aiming to reduce dysphagia: early dose-effect relationships for the swallowing structures. [J]. Int J Radiat Oncol Biol Phys, 2007, 68 (5): 1289-1298.
Wang X S, Yan C, Hu C S, et al. Study of the medial group retropharyngeal node metastasis from nasopharyngeal carcinoma based on 3100 newly diagnosed cases [J]. Oral Oncol, 2014, 50 (11): 1109-1113.
Tang L, Mao Y, Liu L, et al. The volume to be irradiated during selective neck irradiation in nasopharyngeal carcinoma: analysis of the spread patterns in lymph nodes by magnetic resonance imaging. [J]. Cancer, 2009, 115 (3): 680-688.
Wang X S, Hu C S, Ying H M, et al. Patterns of retropharyngeal node metastasis in nasopharyngeal carcinoma. [J]. International Journal of Radiation Oncology Biology Physics, 2009, 73 (1): 194-201.
Liu L Z, Zhang G Y, Xie C M, et al. Magnetic resonance imaging of retropharyngeal lymph node metastasis in nasopharyngeal carcinoma: patterns of spread [J]. International Journal of Radiation Oncology Biology Physics, 2006, 66 (3): 721-730.
Ng S H, Chang J T, Chan S C, et al. Nodal metastases of nasopharyngeal carcinoma: patterns of disease on MRI and FDG PET [J]. European Journal of Nuclear Medicine & Molecular Imaging, 2004, 31 (8): 1073-1080.
Yue D, Xu Y F, Zhang F, et al. Is replacement of the supraclavicular fossa with the lower level classification based on magnetic resonance imaging beneficial in nasopharyngeal carcinoma? [J]. Radiotherapy & Oncology, 2014, 113 (1): 108-114.
Ho F C, Tham I W, Earnest A, et al. Patterns of regional lymph node metastasis of nasopharyngeal carcinoma: A meta-analysis of clinical evidence [J]. Bmc Cancer, 2012, 12 (1): 98.
Grégoire V, Ang K, Budach W, et al. Delineation of the neck node levels for head and neck tumors: A 2013 update. DAHANCA, EORTC, HKNPCSG, NCIC CTG, NCRI, RTOG, TROG consensus guidelines [J]. Radiotherapy & Oncology Journal of the European Society for Therapeutic Radiology & Oncology, 2014, 110 (1): 172-181.
Lin S, Pan J, Han L, et al. Update report of nasopharyngeal carcinoma treated with reduced-volume intensity-modulated radiation therapy and hypothesis of the optimal margin [J]. Radiotherapy & Oncology, 2014, 110 (3): 385-389.
Lee N Y, Zhang Q, Pfister D G, et al. Addition of bevacizumab to standard chemoradiation for locoregionally advanced nasopharyngeal carcinoma (RTOG 0615): a phase 2 multi-institutional trial. [J]. Lancet Oncology, 2012, 13 (2): 172-180.
Radiation Therapy Oncology Group Protocol 02-25. Available at: http://www.rtog.org/members/protocols/0225/0225.pdf. Accessed August 26, 2008.
Radiation Therapy Oncology Group Protocol 06-15. Available at: http://www.rtog.org/members/protocols/0615/0615.pdf. Accessed August 26, 2008, 2008.
Lin S, Pan J, Han L, et al. Nasopharyngeal carcinoma treated with reduced-volume intensity-modulated radiation therapy: report on the 3-year outcome of a prospective series [J]. International Journal of Radiation Oncology Biology Physics, 2009, 75 (4): 1071-1078.
Yi J L, Gao L, Xu G Z, et al. Target volume delineation of IMRT for nasopharyngeal carcinoma-the experience of Cancer Hospital, Chinese Academy of Medical Sciences.[J]. Journal of Cancer Control and Treatment, 2011, 24 (3): 157-163.
Committee of Chinese Clinical Staging of Nasopharyngeal Carcinoma. 2010 Consensus Guidelines for intensity-modulated radiotherapy target volume and dosimetric planning in nasopharyngeal carcinoma [J]. Chin J Radiat Oncol, 2011, 20 (4): 267-269.
Lee A W, Ng W T, Pan J J, et al. International guideline for the delineation of the clinical target volumes (CTV) for nasopharyngeal carcinoma. [J]. Radiotherapy & Oncology, 2017, 126 (1): 25-36.