Head and Neck Unit, Imperial College Healthcare NHS Trust, London, UK; Department of Clinical Oncology, Imperial College Healthcare NHS Trust, London, UK.
Head and Neck Unit, Imperial College Healthcare NHS Trust, London, UK; Department of Otolaryngology, Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and Cancer, Imperial College, London, UK.
Clin Oncol (R Coll Radiol). 2018 Dec;30(12):764-772. doi: 10.1016/j.clon.2018.08.017. Epub 2018 Sep 13.
Management of the clinically node-negative (cN0) neck for parotid tumours remains controversial. Options include observation, elective neck dissection (END) or elective nodal irradiation (ENI). We reviewed the evidence for ENI on a background of current practice among UK clinical oncologists.
We carried out a systematic search of PubMed between 1 January 1980 and 31 December 2016. Articles on patients treated with parotidectomy and either END or ENI, and studies on nodal patterns of disease, were included. UK clinical oncologists were asked to complete an online questionnaire regarding their use of neck radiotherapy in this setting.
From 96 references, 20 studies met the inclusion criteria: 11 reported on END, five on ENI and two on both. Eight studies reported on nodal patterns of disease. The prevalence of occult nodal metastases after END ranged from 0 to 45%. Five year locoregional control was variable (range 64-100%). For ENI, 5 year locoregional control varied from 74 to 100%. High-grade and T3/T4 tumours were factors for nodal relapse after END or ENI, which most commonly occurred in levels I-III. For the survey, 33/50 (66%) of cancer centres responded. Fourteen (42%) centres had guidelines for ENI. Most centres considered high-grade tumours (96%), T3/T4 disease (80%) and lymphovascular invasion (88%) as indications for ENI. Twelve centres (36%) irradiated levels Ib-IV electively; the remaining centres treated other various combinations of nodal levels.
There is heterogeneity in the use and indications for ENI in the UK. ENI is a reasonable alternative to END as elective management for the cN0 neck in patients with high-grade tumours or T3/T4 disease. The elective clinical target volume should at least encompass nodal levels I-III.
对于腮腺肿瘤的临床淋巴结阴性（cN0）颈部的处理仍然存在争议。选择包括观察、选择性颈部清扫术（END）或选择性淋巴结照射（ENI）。我们回顾了英国临床肿瘤学家当前实践背景下关于 ENI 的证据。
我们在 1980 年 1 月 1 日至 2016 年 12 月 31 日期间对 PubMed 进行了系统搜索。纳入接受腮腺切除术和 END 或 ENI 治疗的患者的文章以及疾病淋巴结模式的研究。我们要求英国临床肿瘤学家就其在这种情况下使用颈部放疗的情况填写在线问卷。
从 96 篇参考文献中，有 20 项研究符合纳入标准：11 项报告了 END，5 项报告了 ENI，2 项报告了两者。8 项研究报告了疾病的淋巴结模式。END 后隐匿性淋巴结转移的发生率为 0-45%。5 年局部区域控制率各不相同（范围为 64-100%）。对于 ENI，5 年局部区域控制率从 74%到 100%不等。高级别和 T3/T4 肿瘤是 END 或 ENI 后淋巴结复发的因素，最常见于 I-III 水平。对于调查，50 个癌症中心中有 33 个（66%）做出了回应。14 个（42%）中心有 ENI 指南。大多数中心认为高级别肿瘤（96%）、T3/T4 疾病（80%）和淋巴血管侵犯（88%）是 ENI 的指征。12 个中心（36%）选择性地对 Ib-IV 水平进行了照射；其余中心则采用其他各种淋巴结水平的治疗组合。
英国在 ENI 的使用和适应症方面存在异质性。ENI 是高级别肿瘤或 T3/T4 疾病 cN0 颈部患者 END 作为选择性治疗的合理替代方案。选择性临床靶区至少应包括 I-III 水平的淋巴结。
