Is Elective Irradiation to the Lower Neck Necessary for N0 Nasopharyngeal Carcinoma?

Journal Article · Sun Aug 01 00:00:00 EDT 2010 · International Journal of Radiation Oncology, Biology and Physics

OSTI ID:21436112

Yunsheng, Gao; Guopei, Zhu ^[1]; Jiade, Lu ^[1]; Hongmei, Ying; Ling, Kong; Yongru, Wu ^[1]

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1. Department of Radiation Oncology, Cancer Hospital of Fudan University, Shanghai (China)

Purpose: To summarize our experience and treatment results in lymph node-negative nasopharyngeal carcinoma treated in a single institution. Methods and Materials: From January 2000 to December 2003, 410 patients with lymph node-negative nasopharyngeal carcinoma were retrospectively analyzed. The T-stage distribution was 18.8% in T1, 54.6% in T2 (T2a, 41 patients; T2b, 183 patients), 13.2% in T3, and 13.4% in T4. All patients received radiotherapy to the nasopharynx, skull base, and upper neck drainage areas, including levels II, III, and VA. The dose was 64-74 Gy, 1. 8-2.0 Gy per fraction over 6.5-7.5 weeks to the primary tumor with {sup 60}Co or 6-MV X-rays, and 50-56 Gy to levels II, III, and VA. Residual disease was boosted with either {sup 192}Ir afterloading brachytherapy or small external beam fields. Results: The median follow-up time was 54 months (range, 3-90 months). Four patients developed neck recurrence, and only 1 patient (0.2%) experienced relapse outside the irradiation fields. The 5-year overall survival rate was 84.2%. The 5-year relapse-free survival rate, distant metastasis-free survival rate, and disease-free survival rate were 88.6%, 90.6% and 80.1%, respectively. Both univariate and multivariate analyses demonstrated that T classification was the only significant prognostic factor for predicting overall survival. The observed serious late toxicities were radiation-induced brain damage (7 cases), cranial nerve palsy (16 cases), and severe trismus (13 cases; the distance between the incisors was {<=}1 cm). Conclusion: Elective levels II, III, and VA irradiation is suitable for nasopharyngeal carcinoma without neck lymph node metastasis.

• OSTI ID: 21436112
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 77, Issue 5; Other Information: DOI: 10.1016/j.ijrobp.2009.06.062; PII: S0360-3016(09)01014-1; Copyright (c) 2010 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; ISSN 0360-3016
• Country of Publication: United States
• Language: English

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62 RADIOLOGY AND NUCLEAR MEDICINE
AFTERLOADING
BRACHYTHERAPY
CARCINOMAS
COBALT 60
IRIDIUM 192
LYMPH NODES
METASTASES
NECK
PHARYNX
BETA DECAY RADIOISOTOPES
BETA-MINUS DECAY RADIOISOTOPES
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HEAVY NUCLEI
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IRIDIUM ISOTOPES
ISOMERIC TRANSITION ISOTOPES
ISOTOPES
LYMPHATIC SYSTEM
MEDICINE
MINUTES LIVING RADIOISOTOPES
NEOPLASMS
NUCLEAR MEDICINE
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ODD-ODD NUCLEI
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