title: Is elective irradiation to the lower neck necessary for N0 nasopharyngeal carcinoma?
abstract: OBJECTIVE
  To summarize our experience and treatment results in lymph node-negative nasopharyngeal carcinoma treated in a single institution.
  
  
  METHODS
  From January 2000 to December 2003, 410 patients with lymph node-negative nasopharyngeal carcinoma were retrospectively analyzed. The T-stage distribution was 18.8% in T1, 54.6% in T2 (T2a, 41 patients; T2b, 183 patients), 13.2% in T3, and 13.4% in T4. All patients received radiotherapy to the nasopharynx, skull base, and upper neck drainage areas, including levels II, III, and VA. The dose was 64-74 Gy, 1. 8-2.0 Gy per fraction over 6.5-7.5 weeks to the primary tumor with (60)Co or 6-MV X-rays, and 50-56 Gy to levels II, III, and VA. Residual disease was boosted with either (192)Ir afterloading brachytherapy or small external beam fields.
  
  
  RESULTS
  The median follow-up time was 54 months (range, 3-90 months). Four patients developed neck recurrence, and only 1 patient (0.2%) experienced relapse outside the irradiation fields. The 5-year overall survival rate was 84.2%. The 5-year relapse-free survival rate, distant metastasis-free survival rate, and disease-free survival rate were 88.6%, 90.6% and 80.1%, respectively. Both univariate and multivariate analyses demonstrated that T classification was the only significant prognostic factor for predicting overall survival. The observed serious late toxicities were radiation-induced brain damage (7 cases), cranial nerve palsy (16 cases), and severe trismus (13 cases; the distance between the incisors was < or = 1 cm).
  
  
  CONCLUSIONS
  Elective levels II, III, and VA irradiation is suitable for nasopharyngeal carcinoma without neck lymph node metastasis.
authors.affiliation: Department of Radiation Oncology, Cancer Hospital of Fudan University, Shanghai, China.
authors.forename: Yunsheng
authors.initials: Y
authors.lastname: Gao
authors.forename: Guopei
authors.initials: G
authors.lastname: Zhu
authors.forename: Jiade
authors.initials: J
authors.lastname: Lu
authors.forename: Hongmei
authors.initials: H
authors.lastname: Ying
authors.forename: Ling
authors.initials: L
authors.lastname: Kong
authors.forename: Yongru
authors.initials: Y
authors.lastname: Wu
authors.forename: Chaosu
authors.initials: C
authors.lastname: Hu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods; D005260:Female; D006801:Humans; D007496:Iridium Radioisotopes / Q000627:therapeutic use; D008198:Lymph Nodes; D015182:Lymphatic Irradiation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D009305:Nasopharynx; D009333:Neck; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy; D009367:Neoplasm Staging / Q000379:methods; D018365:Neoplasm, Residual / Q000532:radiotherapy; D011832:Radiation Injuries / Q000473:pathology; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D019291:Skull Base; D015996:Survival Rate; D055815:Young Adult
chemical_list: D007496:Iridium Radioisotopes