The feasibility analysis of omission of elective irradiation to level IB lymph nodes in low-risk nasopharyngeal carcinoma based on the ... View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2017-08-18

AUTHORS

Xiaomin Ou, Yibing Miao, Xiaoshen Wang, Jianhui Ding, Xiayun He, Chaosu Hu

ABSTRACT

BACKGROUND: Level IB metastasis is rare in nasopharyngeal carcinoma (NPC). The purpose of this study is to investigate the high-risk factors for level IB metastasis and evaluate the feasibility of omission of elective irradiation to level IB in the low-risk subgroups in NPC. METHODS: This retrospective study identified 532 patients with NPC treated by definitive radiation in our institution from 2009 to 2010. Level IB nodes were electively irradiated based on the physician's decision. Diagnostic head and neck MRIs were reviewed. The involvements of nodal levels were evaluated according to 2013 updated guidelines of RTOG. The correlations of level IB metastasis and other factors were studied using Chi-square test and logistic regression model. Log-rank tests were used to compare survival rates. Cox proportional-hazards models were used to evaluate the effect of various factors. Patient-reported xerostomia was recoded in every follow-up and the extents of delayed xerostomia at 1 year post-radiation were compared between those with/without elective level IB irradiation. RESULTS: N stage, bilateral nodal metastasis, level II involvement, level IIA involvement, level IIA with multiple levels involvement, maximal axial diameter (MAD) of level IIA nodes > 20 mm, MAD of neck lymph nodes > 30 mm, necrosis of level IIA nodes, extracapsular spread of level IIA correlated with level IB metastasis by univariate analysis. In multivariate analysis (MVA), bilateral nodal involvement, MAD of level IIA nodes > 20 mm or extracapsular spread of level IIA nodes, were independent predictive factors for level IB metastasis. Patients without either these factors were denoted low-risk group and the rest high-risk group. Of the low-risk group, there was no significant difference of regional control and overall survival (OS) between those with or without elective irradiation. The percentage of level IB recurrence of those without elective irradiation was 0.46%. Elective level IB irradiation was not significant upon MVA both for regional control and OS. Of the high-risk group, elective level IB irradiation was marginal significant for regional control, but not for OS upon MVA. No regional recurrence located at level IB. Overall, omission of elective irradiation to level IB reduced the mean doses of submandibular glands, but did not improve patient-reported xerostomia. CONCLUSION: For patients without high-risk factors of level IB metastasis, omission of elective level IB irradiation did not impair regional control and OS in NPC. More... »

PAGES

137

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s13014-017-0869-x

DOI

http://dx.doi.org/10.1186/s13014-017-0869-x

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1091206767

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/28821277


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63 definitive radiation
64 diagnostic head
65 diameter
66 differences
67 doses
68 effect
69 elective irradiation
70 elective level IB irradiation
71 extent
72 extracapsular spread
73 factors
74 feasibility
75 feasibility analysis
76 feasibility of omission
77 gland
78 group
79 guidelines
80 guidelines of RTOG
81 head
82 high-risk factors
83 high-risk group
84 independent predictive factors
85 institutions
86 involvement
87 irradiation
88 level IB irradiation
89 level IB metastasis
90 level IB recurrence
91 level II involvement
92 level IIA involvement
93 level IIA nodes
94 level IIa
95 level Ib
96 level involvement
97 levels
98 log-rank test
99 logistic regression models
100 low-risk group
101 low-risk nasopharyngeal carcinoma
102 low-risk subgroups
103 lymph nodes
104 maximal axial diameter
105 mean doses
106 metastasis
107 model
108 multiple level involvement
109 multivariate analysis
110 nasopharyngeal carcinoma
111 neck MRI
112 neck lymph nodes
113 neck nodal levels
114 necrosis
115 nodal involvement
116 nodal level
117 nodal metastasis
118 nodes
119 omission
120 overall survival
121 patient-reported xerostomia
122 patients
123 percentage
124 physician's decision
125 predictive factors
126 proportional hazards model
127 purpose
128 radiation
129 rate
130 recurrence
131 regional control
132 regional recurrence
133 regression models
134 rest high-risk group
135 retrospective study
136 significant differences
137 spread
138 stage
139 study
140 subgroups
141 submandibular gland
142 survival
143 survival rate
144 test
145 univariate analysis
146 xerostomia
147 years
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