In stage N0-1 nasopharyngeal cancer, elective upper-neck irradiation provides outcomes on par with whole-neck irradiation and with significantly lower rates of long-term toxicity, according to long-term data from a randomized clinical trial.Radiotherapy is a standard treatment option for nasopharyngeal carcinoma with radiotherapy traditionally targeting the entire neck. However, treating such an extensive area can increase toxicity and impair patients' quality of life.
The current noninferiority trial compared 5-year overall survival among patients receiving elective upper-neck or standard whole-neck chemoradiation for N0-N1 nonkeratinizing nasopharyngeal cancer. Overall, 222 received whole-neck irradiation , and 224 received upper-neck irradiation with lower-neck nodes IV and VB omitted for patients who did not have cervical lymph node metastases in that area.revealed that upper-neck irradiation provided comparable regional relapse–free survival; decreased late toxicity, including neck tissue damage, dysphagia, and hypothyroidism; as well as better quality of life, such as less dysphagia and fatigue.
Among 5-year disease-free survivors, patients undergoing less-extensive radiotherapy had lower rates of hypothyroidism , dysphagia , neck tissue damage , and lower-neck common carotid artery stenosis ."These updated data confirmed that of the uninvolved neck is a standard of care in N0-1 , providing outstanding efficacy and reduced long-term toxicity, and might retain more immune function," the authors concluded.
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