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Results of a phase 2 study examining the effects of omitting elective neck irradiation to nodal levels IV and Vb in patients with N(0-1) nasopharyngeal carcinoma.
- Source :
-
International journal of radiation oncology, biology, physics [Int J Radiat Oncol Biol Phys] 2013 Mar 15; Vol. 85 (4), pp. 929-34. Date of Electronic Publication: 2012 Sep 11. - Publication Year :
- 2013
-
Abstract
- Purpose: To evaluate the patterns of nodal failure and toxicity in clinically negative necks of N0-1 nasopharyngeal carcinoma (NPC) patients who were treated with intensity modulated radiation therapy (IMRT) but did not receive elective neck irradiation (ENI) to level IV and Vb nodes.<br />Methods and Materials: We conducted a phase 2 prospective study in N0-1 NPC patients treated with IMRT. ENI included the retropharyngeal nodes and levels II to Va but omitted levels IV and Vb in clinically negative necks. Patterns of nodal failure, regional control (RC), and late toxicity were evaluated.<br />Results: Between 2001 and 2008, a total of 212 patients (128 N0 and 84 N1) were enrolled in the study. Seven patients (4 in-field and 3 out-of-field) developed nodal failure. One patient (0.5%) developed nodal failure at level Vb, but no patients developed nodal failure at level IV. The 5-year RC rates of the entire group, N0 patients and N1 patients were 95.6%, 98.2%, and 91.3%, respectively. Fifteen patients (7.1%) developed distant metastases. The 5-year distant failure-free survival (DFFS) and overall survival (OS) rates were 91.4% and 89.8%, respectively. The rates of grade 2 or greater skin dystrophy, subcutaneous fibrosis and xerostomia were 6.2%, 16.6%, and 17.9%, respectively.<br />Conclusions: The rate of out-of-field nodal failure when omitting ENI to levels IV and Vb in clinically negative necks of patients with N0-1 NPC was extremely low; therefore, a further phase 3 study is warranted.<br /> (Copyright © 2013 Elsevier Inc. All rights reserved.)
- Subjects :
- Adolescent
Adult
Aged
Brachytherapy
Carcinoma
Carcinoma, Squamous Cell mortality
Carcinoma, Squamous Cell pathology
Carcinoma, Squamous Cell secondary
Disease-Free Survival
Female
Humans
Male
Middle Aged
Nasopharyngeal Carcinoma
Nasopharyngeal Neoplasms mortality
Nasopharyngeal Neoplasms pathology
Nasopharyngeal Neoplasms secondary
Neck
Neoplasm Staging methods
Prospective Studies
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted methods
Survival Rate
Xerostomia
Young Adult
Carcinoma, Squamous Cell radiotherapy
Lymphatic Irradiation
Lymphatic Metastasis
Nasopharyngeal Neoplasms radiotherapy
Organ Sparing Treatments methods
Subjects
Details
- Language :
- English
- ISSN :
- 1879-355X
- Volume :
- 85
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- International journal of radiation oncology, biology, physics
- Publication Type :
- Academic Journal
- Accession number :
- 22975606
- Full Text :
- https://doi.org/10.1016/j.ijrobp.2012.07.2356