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Abstract Purpose To address the regional lymph node (RLN) distribution and the long‐term efficacy in unilateral nasopharyngeal carcinoma (NPC), providing elective irradiation for RLN with intensity‐modulated radiotherapy (IMRT). Methods The involvement of clinical data of 136 patients with unilateral NPC, who underwent IMRT from November 2003 to December 2020 were analyzed retrospectively. The therapeutic effect and failure pattern of RLN metastasis were evaluated. Results Of 57.1% patients have bilateral RLN metastasis. The rate of contralateral RLNs metastasis is lower than that of ipsilateral RLNs. Contralateral RLN metastasis mainly occurs in level VIIa (39.0%) and II (38.2%). While level IVa is only 0.7%, and none of RLN metastasis was found in level IVb and Va. The median follow‐up was 70 months, and the 3‐, 5‐and 10‐year regional recurrence‐free survival (RRFS) were 94.1%, 93.1%, and 93.1%, respectively. Conclusion Routine prophylactic irradiation may not include contralateral lower neck LN and level Va for N0‐1 unilateral NPC.

Abstract Background This study presents a summary of the clinical characteristics of non‐nasopharyngeal lymphoepithelial carcinoma (NNPLEC), effects of combined modality treatment and prognostic value of plasma Epstein–Barr virus (EBV) deoxyribonucleic acid (DNA) load, with the aim of providing a reference framework for optimizing treatment practices and outcomes. Methods Patients with NNPLEC treated by our center between January 2000 and December 2020 were retrospectively reviewed. Results In total, 728 patients were included. The lung was identified as the most common primary tumor site (64.0%), followed by the salivary gland (19.2%). A total of 539 (74.0%) patients underwent surgery, 459 (63.0%) received chemotherapy, and 361 (49.6%) were subjected to radiotherapy. The median follow‐up time was 45 months (range, 6–212 months) and 5‐year overall survival (OS) was 79.1%. Increased plasma EBV‐DNA load of >513.5 copies/mL was predictive of disease progression, with a specificity of 98.1% and a sensitivity of 98.9%. In multivariate Cox analysis, N stage, surgery, and radiotherapy were independent prognostic factors for both OS and PFS. Radiotherapy significantly improves OS in comparison with no radiotherapy group for salivary LEC, while surgery significantly improves OS for pulmonary LEC. Conclusion Based on our analysis, surgery and radiotherapy are associated with better OS and PFS for NNPLEC. Radiotherapy could be recommended for salivary LEC, while surgery remains the primary treatment strategy for pulmonary LEC patients. An increased plasma EBV‐DNA load of >513.5 copies/mL is strongly predictive of disease progression, supporting the importance of regular evaluation of plasma EBV‐DNA as part of the diagnostic routine.