title: A randomized clinical trial comparing prophylactic upper versus whole-neck irradiation in the treatment of patients with node-negative nasopharyngeal carcinoma.
abstract: BACKGROUND
  This study sought to compare the clinical outcomes of upper versus whole-neck prophylactic irradiation in the treatment of patients with node-negative nasopharyngeal carcinoma (NPC).
  
  
  METHODS
  Between November 2005 and June 2012, 301 patients with node-negative NPC were randomly assigned to receive primary plus prophylactic upper neck irradiation (UNI, 153 patients) or primary plus whole-neck irradiation (WNI, 148 patients). Patients in both groups received irradiation to the primary tumor and the upper neck nodal regions, and patients in the WNI group also received irradiation to the lower neck. The main endpoint of the study was to compare the lower neck control rate between the 2 groups.
  
  
  RESULTS
  With a median follow-up period of 39 months (range, 6-84 months), no patient in either group had a cervical node relapse. The overall survival at 3 years was 89.5% (95% confidence interval [CI] = 84.1%-95.0%) in the UNI group and 87.4% (95% CI = 81.4%-93.5%) in the WNI group (hazard ratio [HR] = 0.866, 95% CI = 0.41-1.82; P = .70). The 3-year relapse-free survival rate was 89.8% and 89.3% (95% CI = 84.2%-95.3% and 83.7%-94.8%, HR = 0.914, 95% CI = 0.42-2.00; P = .82), and the 3-year metastasis-free survival rate was 91.7% and 90.9% (95% CI = 87.0%-96.5% and 85.7%-96.1%) for the UNI and WNI groups, respectively (HR = 1.007, 95% CI = 0.44-2.32; P = .99).
  
  
  CONCLUSIONS
  Prophylactic upper neck irradiation is sufficient for patients with node-negative NPC.
authors.affiliation: Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, China.
authors.forename: Jin-Gao
authors.initials: JG
authors.lastname: Li
authors.forename: Xia
authors.initials: X
authors.lastname: Yuan
authors.forename: Ling-Ling
authors.initials: LL
authors.lastname: Zhang
authors.forename: Yi-Qiang
authors.initials: YQ
authors.lastname: Tang
authors.forename: Lan
authors.initials: L
authors.lastname: Liu
authors.forename: Xiao-Dan
authors.initials: XD
authors.lastname: Chen
authors.forename: Xiao-Chang
authors.initials: XC
authors.lastname: Gong
authors.forename: Gui-Fen
authors.initials: GF
authors.lastname: Wan
authors.forename: Yu-Lu
authors.initials: YL
authors.lastname: Liao
authors.forename: Jian-Ming
authors.initials: JM
authors.lastname: Ye
authors.forename: Fan
authors.initials: F
authors.lastname: Ao
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology / Q000528:radiation effects*; D008297:Male; D008875:Middle Aged; D000077274:Nasopharyngeal Carcinoma; D009303:Nasopharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D009333:Neck; D011878:Radiotherapy / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated; D055502:Secondary Prevention / Q000379:methods*; D016896:Treatment Outcome
keywords: lymph node metastases; nasopharyngeal carcinoma; radiotherapy; relapse; selective neck irradiation