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. 2017 Mar 24;36(1):32.
doi: 10.1186/s40880-017-0199-2.

Clinical treatment considerations in the intensity-modulated radiotherapy era for patients with N0-category nasopharyngeal carcinoma and enlarged neck lymph nodes

Hao Peng  1   2 , Lei Chen  1   2 , Rui Guo  1   2 , Yuan Zhang  1   2 , Wen-Fei Li  1   2 , Yan-Ping Mao  1   2 , Ying Sun  1   2 , Fan Zhang  1   2 , Li-Zhi Liu  1   3 , Li Tian  1   3 , Jun Ma  4   5
Affiliations

Clinical treatment considerations in the intensity-modulated radiotherapy era for patients with N0-category nasopharyngeal carcinoma and enlarged neck lymph nodes

Hao Peng et al. Chin J Cancer. .

Abstract

Background: Nasopharyngeal carcinoma (NPC) shows a high proportion of lymph node metastasis, and treatment guidelines have been developed for positive nodes. However, no irradiation guidelines have been proposed for patients with enlarged neck lymph nodes (ENLNs) that do not meet the radiological criteria of 10 mm in diameter for positive lymph nodes. This study aimed to determine the prognostic value and radiation dose for ENLNs in N0-category NPC patients treated with intensity-modulated radiotherapy (IMRT).

Methods: We reviewed the medical data of 251 patients with non-metastatic, N0-category NPC treated with IMRT. Receiver operating characteristic curves were used to calculate the cut-off value of the ENLN diameter for the prediction of disease failure. The biological equivalent dose (BED) for ENLNs was calculated. Patient survival was compared between the small and large ENLN groups. Independent prognostic factors were identified using the Cox proportional hazards model.

Results: The estimated 4-year regional relapse-free survival rate was higher in patients with ENLNs ≥5.5 mm than in those with ENLNs <5.5 mm (100% vs. 98.8%, P = 0.049), whereas disease-free, overall, and distant metastasis-free survival rates were similar between the two groups. After adjusting for various factors, ENLN diameter was not identified as an independent prognostic factor (P > 0.05 for all survival rates). In the subgroup analysis, patients receiving BED ≥72 Gy had a similar prognosis as patients receiving BED <72 Gy in both the small and large ENLN groups. The multivariate analysis also confirmed that BED ≥72 Gy was not associated with significantly improved prognosis in patients with N0-category NPC.

Conclusions: A BED of 72 Gy to ENLNs is considerably sufficient to provide a clinical benefit to patients with N0-category NPC. Prospective studies are warranted to validate the findings in the present study.

Keywords: Biological equivalent dose; Enlarged neck lymph node; Intensity-modulated radiotherapy; N0-category; Nasopharyngeal carcinoma; Prognosis.

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Figures

Fig. 1
Fig. 1
Receiver operating characteristic curve analysis of the short diameter of the largest enlarged neck lymph node (ENLN) in patients with N0-category nasopharyngeal carcinoma (NPC) for the prediction of disease-free survival. AUC area under the curve
Fig. 2
Fig. 2
Kaplan–Meier survival curves of patients with N0-category NPC and ENLN in the small ENLN (<5.5 mm) and large ENLN (≥5.5 mm) groups. a Regional relapse-free survival; b disease-free survival; c overall survival; d distant metastasis-free survival. NPC nasopharyngeal carcinoma, ENLN small neck lymph node
Fig. 3
Fig. 3
Kaplan–Meier survival curves of N0-category NPC patients in the small ENLN group stratified by a biological equivalent dose (BED) < or ≥72 Gy. a Regional relapse-free survival; b disease-free survival; c overall survival; d distant metastasis-free survival. NPC nasopharyngeal carcinoma, ENLN enlarged neck lymph node
Fig. 4
Fig. 4
Kaplan–Meier curves for prognostication by ENLN ≥5.5 mm stratified by a BED < or ≥72 Gy: (a) disease-free survival; (b) overall survival; (c) distant metastasis-free survival
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