title: The pattern of nodal recurrence following definitive radiotherapy for nasopharyngeal carcinoma.
abstract: BACKGROUND
  The pattern of nodal metastasis in previously untreated nasopharyngeal carcinoma (NPC) has been studied and reported. In order to analyse the pattern of recurrent nodal disease in previously treated NPC, a retrospective study on 68 patients who underwent radical neck dissection for regionally recurrent NPC was conducted.
  
  
  METHODS
  Seventy-four neck dissections were performed on 68 patients who developed nodal recurrence after a mean disease-free interval of 39.2 months. None of the patients had evidence of local or systemic disease at the time of surgery. Histopathological reports of the 74 neck dissections were analysed with regard to the number of positive nodes as well as the number of involved nodal levels.
  
  
  RESULTS
  Of the 65 neck dissection specimens with analysable data, 31 showed metastatic disease at a single nodal level with a mean number of positive nodes of 1.2, while 34 showed metastatic disease at multiple levels with a mean number of positive nodes of 6.6. Nodal recurrence occurred at level II with the greatest frequency (78.5%). Of the 31 specimens with single level nodal involvement, 21 (67.7%) occurred at level II. Isolated involvement at the other levels did occur, but was uncommon (range 3-16%). Of the 34 specimens with multiple level nodal involvement, 30 (88.2%) showed involvement at level II. Once more than one level was involved, the frequency of involvement at any given level was at least 30%.
  
  
  CONCLUSIONS
  The predominant involvement at level II and the high frequencies of involvement at all levels support the use of a classical radical neck dissection in treating recurrent nodal disease in NPC.
authors.affiliation: Department of Otorhinolaryngology, Tan Tock Seng Hospital, National Cancer Centre, Singapore, Singapore.
authors.forename: M L
authors.initials: ML
authors.lastname: Khoo
authors.forename: K C
authors.initials: KC
authors.lastname: Soo
authors.forename: D T
authors.initials: DT
authors.lastname: Lim
authors.forename: K W
authors.initials: KW
authors.lastname: Fong
authors.forename: C H
authors.initials: CH
authors.lastname: Goh
authors.forename: D S
authors.initials: DS
authors.lastname: Sethi
mesh_terms: D002277:Carcinoma / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D009303:Nasopharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D037981:Neck Dissection / Q000706:statistics & numerical data; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D012189:Retrospective Studies