Department of Radiotherapy, Peking University Cancer Hospital Yunnan, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming Yunnan, P.R. China.
Department of Radiation Oncology, Hunan Cancer Hospital & the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha Hunan, P.R. China.
Cancer Med. 2024 Feb;13(3):e6723. doi: 10.1002/cam4.6723. Epub 2023 Dec 29.
To explore the feasibility of individualized elective prophylactic neck irradiation (iEPNI) for optimizing current approach by investigating metastatic lymph nodes (LNs) distribution in nasopharyngeal carcinoma (NPC).
Records of 870 NPC patients without distant metastasis in Hunan Cancer Hospital from January 2019 to December 2019 were reviewed. LNs' locations were identified based on the 2013 guidelines. The intra-regional lymphatic drainage (IRLD) areas included Station 1st (level VIIa and II), Station 2nd (level III and Va), and Station 3rd (level IV, Vb, and Vc). Other levels were categorized as extra-regional areas.
Among the 870 patients, 94.5% cases exhibited LNs metastasis, including unilateral metastasis in 198 patients and bilateral metastasis in 624 patients. In the whole cohort, the most common involved IRLD areas were level IIb (87.1%), VIIa (80.0%), IIa (61.8%), Va (30.6%), IV (21.4%), Vb (8.9%), and Vc (1.1%). Besides, rates of LNs metastasis in Station 1st, 2nd, and 3rd were 94.3%, 61.1%, and 22.9%, respectively. Only four patients (4, 0.5%) revealed skipping metastasis among the three stations.
Lymph node metastasis follows an organized pattern from Station 1st to 3rd with scarce skipping metastasis. A potential iEPNI strategy of prophylactic neck irradiation to the ipsilateral latter node-negative station appears promising in NPC patients. Further prospective investigations are warranted to validate the approach.
通过研究鼻咽癌（NPC）转移淋巴结（LNs）的分布，探讨个体化选择性预防性颈部照射（iEPNI）优化当前治疗策略的可行性。
回顾 2019 年 1 月至 12 月在湖南省肿瘤医院就诊的 870 例无远处转移的 NPC 患者的病历资料。基于 2013 年的指南确定 LNs 的位置。区域性淋巴结引流（IRLD）区域包括第 1 站（水平 VIIa 和 II）、第 2 站（水平 III 和 Va）和第 3 站（水平 IV、Vb 和 Vc）。其他水平被归类为区域外区域。
在 870 例患者中，94.5%的患者存在 LNs 转移，其中 198 例为单侧转移，624 例为双侧转移。在整个队列中，最常见的累及 IRLD 区域为水平 IIb（87.1%）、VIIa（80.0%）、IIa（61.8%）、Va（30.6%）、IV（21.4%）、Vb（8.9%）和 Vc（1.1%）。此外，第 1 站、第 2 站和第 3 站的 LNs 转移率分别为 94.3%、61.1%和 22.9%。三个站中仅有 4 例（4，0.5%）存在跳跃性转移。
淋巴结转移呈从第 1 站到第 3 站的有序模式，跳跃性转移很少见。对于 NPC 患者，采用同侧无后者淋巴结阴性站的个体化选择性预防性颈部照射（iEPNI）策略可能具有广阔的应用前景。需要进一步的前瞻性研究来验证该方法。
