Search

• UNI had similar efficacy and fewer toxicities compared with WNI for patients with unilateral or bilateral node-negative nasopharyngeal carcinoma； • The lower-neck sparing of the uninvolved neck is a valid option for N0, N1, and even unilateral N3 diseases in nasopharyngeal carcinoma. This meta-analysis aimed to investigate the efficacy and radiation-related toxicities of upper-neck irradiation (UNI) over whole-neck irradiation (WNI) in patients with unilateral or bilateral node-negative nasopharyngeal carcinoma. We conducted a systematic review to identify studies comparing survival and toxicities between UNI and WNI by searching key databases up to Aug 2022. Hazard ratios (HRs) with 95% confidence intervals (CIs) for regional recurrence-free survival (RRFS), local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) were pooled using R 4.0.5. Risk ratios (RRs) for acute and late radiation-related toxicities were also pooled. Subgroup analyses according to nodal status, radiotherapy techniques, and study type were conducted. Eight studies enrolling 2568 patients were included. Patients who received UNI showed similar RRFS (HR 0.99, 95% CI 0.57–1.74, P = 0.975), LRFS (HR 0.86, 95% CI 0.53–1.41, P = 0.559), DMFS (HR 0.90, 95% CI 0.63–1.29, P = 0.581), PFS (1.10, 95% CI 0.73–1.67, P = 0.642), and OS (1.03, 95% CI 0.77–1.37, P = 0.866) compared with WNI. When stratified by nodal status, the pooled HRs for RRFS in patient subgroups with stage N0 disease, stage N1 with only retropharyngeal lymph nodes metastasis, and unilateral cervical lymph node metastasis were 0.46 (95% CI 0.04–5.16, P = 0.529), 1.12 (95% CI 0.29–4.38, P = 0.872), and 1.02 (95% CI 0.48–2.16, P = 0.968) respectively, none of which reached statistical significance. UNI was associated with lower incidences of grade 1–2 hypothyroidism (RR 0.75, 95% CI 0.57–0.97, P = 0.031) and grade 1–2 dysphagia (RR 0.58, 95% CI 0.42–0.80, P < 0.001) compared with WNI. UNI had similar efficacy and fewer toxicities compared with WNI for patients with unilateral or bilateral node-negative nasopharyngeal carcinoma. The lower-neck sparing of the uninvolved neck is a valid option for N0, N1, and even unilateral N3 diseases in nasopharyngeal carcinoma. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Carotid artery stenosis is a complication of neck irradiation. We describe the immediate and long-term results of surgical treatment. Methods: This was a retrospective single centre study. From 1996 to 2009, 24 consecutive patients who had in the past received neck radiation therapy (mean 12 years, 1–41 years) underwent 27 primary carotid artery revascularisation procedures. Six patients (23%) had previous radical neck dissection, three permanent tracheostomies and one cervicoplasty with pectoral muscle flap. Indications for surgery included symptomatic (five transient ischaemic attacks (TIAs), four strokes; 34%) and asymptomatic (18 patients, 66%) stenosis. Four patients had occlusion of the contralateral carotid. General anaesthesia without shunting was used with measurement of stump pressure. Carotid interposition bypass grafting included 23 vein grafts and three Polytetrafluoroethylene (PTFE) grafts. Results: No perioperative deaths or central neurological events occurred. Three patients suffered transient cranial nerve injuries. Eleven patients died during follow-up, mean interval of 28 months (range 6–120 months), of causes unrelated to surgery. Five patients had recurrent bypass stenosis with one TIA and one stroke. All other surviving patients remained asymptomatic. Conclusion: Despite no comparative study as evidence, we think that the perioperative risk of stroke is at least comparable with the risk encountered for angioplasty procedures. [Copyright &y& Elsevier]

Background: Management of the neck in oropharyngeal carcinoma varies due to a lack of clarity of patterns of lymphatic drainage and concern of failure in the contralateral neck. With recent advances in transoral surgical techniques, surgical management has become increasingly prevalent as the primary treatment modality. We compare international practice patterns between surgical and radiation oncologists.Methods: A survey of neck management practice patterns was developed and pilot tested by 6 experts. The survey comprised items eliciting the nature of clinical practice, as well as patterns of neck management depending on extent of nodal disease and location and extent of primary site disease. Proportions of surgical and radiation oncologists treating the neck bilaterally were compared using the chi-squared statistic.Results: Two-hundred and twenty-two responses were received from 172 surgical oncologists, 44 radiation oncologists, 3 medical oncologists, and 3 non-oncologists from 32 different countries. For tongue base cancers within 1 cm of midline (67% vs. 100%, p < 0.001), and for tonsil cancers with extension to the medial 1/3 of the soft palate (65% vs. 100%, p < 0.001) or tongue base (77% vs. 100%, p < 0.001), surgical oncologists were less likely to treat the neck bilaterally. For isolated tonsil fossa cancers with no nodal disease, both surgical and radiation oncologists were similarly likely to treat unilaterally (99% vs. 97%, p = NS). However, with increasing nodal burden, radiation oncologists were more likely to treat bilaterally for scenarios with a single node < 3 cm (15% vs. 2%, p < 0.001), a single node with extranodal extension (41% vs. 18%, p < 0.001), multiple positive nodes (55% vs. 23% p < 0.001), and node(s) > 6 cm (86% vs. 33%, p < 0.001). For tumors with midline extension, even with a negative PET in the contralateral neck, the majority of surgical and radiation oncologists would still treat the neck bilaterally (53% and 84% respectively).Conclusions: The present study demonstrates significant practice pattern variability for management of the neck in patients with lateralized oropharyngeal carcinoma. Surgical oncologists are less likely to treat the neck bilaterally, regardless of tumor location or nodal burden. Even in the absence of disease in the contralateral neck on imaging, them majority of practitioners are likely to treat bilaterally when the disease approaches midline. [ABSTRACT FROM AUTHOR]