Patterns of regional lymph node metastasis of nasopharyngeal carcinoma: A meta-analysis of clinical evidence
Identifieur interne : 004037 ( Main/Exploration ); précédent : 004036; suivant : 004038Patterns of regional lymph node metastasis of nasopharyngeal carcinoma: A meta-analysis of clinical evidence
Auteurs : Francis Ch Ho ; Ivan Wk Tham ; Arul Earnest ; Khai Mun Lee ; Jiade J. LuSource :
- BMC Cancer [ 1471-2407 ] ; 2012.
Abstract
The characteristics of cervical lymphatic metastasis in nasopharyngeal carcinoma (NPC) are not completely understood. As such, radiotherapy to the entire lymphatic of the neck bilaterally has been empirically practiced even in early stage disease, although not supported by clinical evidence. We studied the pattern and probability of nodal metastasis through a meta-analysis of published evidences, with an aim to establish an evidence-based guideline for selecting and delineation of clinical target volume of neck lymphatics for conformation radiation for NPC.
A literature search yielded an initial 411 original articles, and 13 studies with 2920 NPC cases staged via MRI were included in this analysis. The occurrence of nodal metastasis was calculated and analyzed according to the respective regional nodal levels.
85% of NPC cases presented with lymphadenopathy. The most commonly involved regions include retropharyngeal (69%) and level II lymph nodes (70%). The overall probability of levels III, IV, and V nodal involvement are 45%, 11%, and 27%, respectively. Low-risk node groups included the supraclavicular, levels IA/IB and VI nodes, and parotid nodes with involvement rates at 3%, 0%, 3%, 0%, and 1%, respectively. Nodal metastases followed an orderly pattern and the probability of "skip" metastasis between levels varied between 0.5-7.9%.
Lymph node metastasis in NPC follows a predictable and orderly pattern. The rarity of metastasis in certain nodal groups and "skip" metastasis suggest that reduced treatment volume is feasible in conformal radiotherapy for NPC.
Url:
DOI: 10.1186/1471-2407-12-98
PubMed: 22433671
PubMed Central: 3353248
Affiliations:
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Patterns of regional lymph node metastasis of nasopharyngeal carcinoma: A meta-analysis of clinical evidence</title><author><name sortKey="Ho, Francis Ch" sort="Ho, Francis Ch" uniqKey="Ho F" first="Francis Ch" last="Ho">Francis Ch Ho</name><affiliation><nlm:aff id="I1">Department of Radiation Oncology, National University Cancer Institute, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Republic of Singapore</nlm:aff><wicri:noCountry code="subfield">Republic of Singapore</wicri:noCountry></affiliation></author><author><name sortKey="Tham, Ivan Wk" sort="Tham, Ivan Wk" uniqKey="Tham I" first="Ivan Wk" last="Tham">Ivan Wk Tham</name><affiliation><nlm:aff id="I1">Department of Radiation Oncology, National University Cancer Institute, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Republic of Singapore</nlm:aff><wicri:noCountry code="subfield">Republic of Singapore</wicri:noCountry></affiliation></author><author><name sortKey="Earnest, Arul" sort="Earnest, Arul" uniqKey="Earnest A" first="Arul" last="Earnest">Arul Earnest</name><affiliation><nlm:aff id="I2">Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, 8 College Road, Singapore, Singapore 169857</nlm:aff><wicri:noCountry code="subfield">Singapore 169857</wicri:noCountry></affiliation></author><author><name sortKey="Lee, Khai Mun" sort="Lee, Khai Mun" uniqKey="Lee K" first="Khai Mun" last="Lee">Khai Mun Lee</name><affiliation><nlm:aff id="I1">Department of Radiation Oncology, National University Cancer Institute, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Republic of Singapore</nlm:aff><wicri:noCountry code="subfield">Republic of Singapore</wicri:noCountry></affiliation></author><author><name sortKey="Lu, Jiade J" sort="Lu, Jiade J" uniqKey="Lu J" first="Jiade J" last="Lu">Jiade J. Lu</name><affiliation><nlm:aff id="I1">Department of Radiation Oncology, National University Cancer Institute, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Republic of Singapore</nlm:aff><wicri:noCountry code="subfield">Republic of Singapore</wicri:noCountry></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22433671</idno><idno type="pmc">3353248</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3353248</idno><idno type="RBID">PMC:3353248</idno><idno type="doi">10.1186/1471-2407-12-98</idno><date when="2012">2012</date><idno type="wicri:Area/Pmc/Corpus">003B55</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">003B55</idno><idno type="wicri:Area/Pmc/Curation">003B54</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">003B54</idno><idno type="wicri:Area/Pmc/Checkpoint">002826</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">002826</idno><idno type="wicri:Area/Ncbi/Merge">004C02</idno><idno type="wicri:Area/Ncbi/Curation">004C02</idno><idno type="wicri:Area/Ncbi/Checkpoint">004C02</idno><idno type="wicri:Area/Main/Merge">004051</idno><idno type="wicri:Area/Main/Curation">004037</idno><idno type="wicri:Area/Main/Exploration">004037</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Patterns of regional lymph node metastasis of nasopharyngeal carcinoma: A meta-analysis of clinical evidence</title><author><name sortKey="Ho, Francis Ch" sort="Ho, Francis Ch" uniqKey="Ho F" first="Francis Ch" last="Ho">Francis Ch Ho</name><affiliation><nlm:aff id="I1">Department of Radiation Oncology, National University Cancer Institute, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Republic of Singapore</nlm:aff><wicri:noCountry code="subfield">Republic of Singapore</wicri:noCountry></affiliation></author><author><name sortKey="Tham, Ivan Wk" sort="Tham, Ivan Wk" uniqKey="Tham I" first="Ivan Wk" last="Tham">Ivan Wk Tham</name><affiliation><nlm:aff id="I1">Department of Radiation Oncology, National University Cancer Institute, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Republic of Singapore</nlm:aff><wicri:noCountry code="subfield">Republic of Singapore</wicri:noCountry></affiliation></author><author><name sortKey="Earnest, Arul" sort="Earnest, Arul" uniqKey="Earnest A" first="Arul" last="Earnest">Arul Earnest</name><affiliation><nlm:aff id="I2">Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, 8 College Road, Singapore, Singapore 169857</nlm:aff><wicri:noCountry code="subfield">Singapore 169857</wicri:noCountry></affiliation></author><author><name sortKey="Lee, Khai Mun" sort="Lee, Khai Mun" uniqKey="Lee K" first="Khai Mun" last="Lee">Khai Mun Lee</name><affiliation><nlm:aff id="I1">Department of Radiation Oncology, National University Cancer Institute, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Republic of Singapore</nlm:aff><wicri:noCountry code="subfield">Republic of Singapore</wicri:noCountry></affiliation></author><author><name sortKey="Lu, Jiade J" sort="Lu, Jiade J" uniqKey="Lu J" first="Jiade J" last="Lu">Jiade J. Lu</name><affiliation><nlm:aff id="I1">Department of Radiation Oncology, National University Cancer Institute, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Republic of Singapore</nlm:aff><wicri:noCountry code="subfield">Republic of Singapore</wicri:noCountry></affiliation></author></analytic><series><title level="j">BMC Cancer</title><idno type="eISSN">1471-2407</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>The characteristics of cervical lymphatic metastasis in nasopharyngeal carcinoma (NPC) are not completely understood. As such, radiotherapy to the entire lymphatic of the neck bilaterally has been empirically practiced even in early stage disease, although not supported by clinical evidence. We studied the pattern and probability of nodal metastasis through a meta-analysis of published evidences, with an aim to establish an evidence-based guideline for selecting and delineation of clinical target volume of neck lymphatics for conformation radiation for NPC.</p></sec><sec><title>Methods</title><p>A literature search yielded an initial 411 original articles, and 13 studies with 2920 NPC cases staged via MRI were included in this analysis. The occurrence of nodal metastasis was calculated and analyzed according to the respective regional nodal levels.</p></sec><sec><title>Results</title><p>85% of NPC cases presented with lymphadenopathy. The most commonly involved regions include retropharyngeal (69%) and level II lymph nodes (70%). The overall probability of levels III, IV, and V nodal involvement are 45%, 11%, and 27%, respectively. Low-risk node groups included the supraclavicular, levels IA/IB and VI nodes, and parotid nodes with involvement rates at 3%, 0%, 3%, 0%, and 1%, respectively. Nodal metastases followed an orderly pattern and the probability of "skip" metastasis between levels varied between 0.5-7.9%.</p></sec><sec><title>Conclusions</title><p>Lymph node metastasis in NPC follows a predictable and orderly pattern. 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Ioannidis</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Stroup, Df" uniqKey="Stroup D">DF Stroup</name></author><author><name sortKey="Berlin, Ja" uniqKey="Berlin J">JA Berlin</name></author><author><name sortKey="Morton, Sc" uniqKey="Morton S">SC Morton</name></author><author><name sortKey="Olkin, I" uniqKey="Olkin I">I Olkin</name></author><author><name sortKey="Williamson, Gd" uniqKey="Williamson G">GD Williamson</name></author><author><name sortKey="Rennie, D" uniqKey="Rennie D">D Rennie</name></author><author><name sortKey="Moher, D" uniqKey="Moher D">D Moher</name></author><author><name sortKey="Becker, Bj" uniqKey="Becker B">BJ Becker</name></author><author><name sortKey="Sipe, Ta" uniqKey="Sipe T">TA Sipe</name></author><author><name sortKey="Thacker, Sb" uniqKey="Thacker S">SB Thacker</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Swartz, Mk" uniqKey="Swartz M">MK Swartz</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list></list><tree><noCountry><name sortKey="Earnest, Arul" sort="Earnest, Arul" uniqKey="Earnest A" first="Arul" last="Earnest">Arul Earnest</name><name sortKey="Ho, Francis Ch" sort="Ho, Francis Ch" uniqKey="Ho F" first="Francis Ch" last="Ho">Francis Ch Ho</name><name sortKey="Lee, Khai Mun" sort="Lee, Khai Mun" uniqKey="Lee K" first="Khai Mun" last="Lee">Khai Mun Lee</name><name sortKey="Lu, Jiade J" sort="Lu, Jiade J" uniqKey="Lu J" first="Jiade J" last="Lu">Jiade J. Lu</name><name sortKey="Tham, Ivan Wk" sort="Tham, Ivan Wk" uniqKey="Tham I" first="Ivan Wk" last="Tham">Ivan Wk Tham</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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