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Prognostic value of parotid lymph node metastasis in patients with nasopharyngeal carcinoma receiving intensity-modulated radiotherapy.

Zhang Y, Li WF, Chen L, Mao YP, Guo R, Zhang F, Peng H, Liu LZ, Li L, Liu Q, Ma J - Sci Rep (2015)

Bottom Line: Ten of the 21 patients received irradiation of the involved PLNs; the PLN recurrence rate was significantly higher for patients who received no irradiation; thus only patients with irradiated PLN were included in prognostic analyses.PLN involvement had a significantly higher hazard ratio (HR) for distant failure than N2 disease and similar HR to N3 disease.In conclusion, PLN metastasis is rare in NPC and was associated with similarly poor DMFS as N3 disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China.

ABSTRACT
The prognostic value and staging category of parotid lymph node (PLN) metastasis in nasopharyngeal carcinoma (NPC) remain unknown. We retrospectively reviewed MRI scans and medical records for 1811 NPC patients who received intensity-modulated radiotherapy. The diagnosis of PLN metastasis was mainly based on MRI follow-up. Twenty-five positive PLNs in 21/1811 patients were identified; the incidence of PLN metastasis was 1.2%. PLN metastasis was significantly associated with advanced N-category and stage. Ten of the 21 patients received irradiation of the involved PLNs; the PLN recurrence rate was significantly higher for patients who received no irradiation; thus only patients with irradiated PLN were included in prognostic analyses. PLN metastasis was associated with significantly poorer progression-free survival, overall survival and distant metastasis-free survival (DMFS), but not regional or local relapse-free survival, in univariate analysis. In multivariate analysis, PLN metastasis was also significantly associated with poor DMFS. PLN involvement had a significantly higher hazard ratio (HR) for distant failure than N2 disease and similar HR to N3 disease. In conclusion, PLN metastasis is rare in NPC and was associated with similarly poor DMFS as N3 disease. PLN metastasis should be suspected in advanced nodal disease, but diagnosed with care before administering aggressive treatment.

No MeSH data available.


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Flowchart illustrating the identification of positive parotid lymph nodes.
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f1: Flowchart illustrating the identification of positive parotid lymph nodes.

Mentions: Among the 1811 patients with NPC, 45 parotid nodules with size ≥5 mm were identified in 40 patients in follow-up MRI imaging. Of these 40 patients, only four underwent pretreatment FNAC: one node was a metastatic PLN, one node was reactive lymphoid hyperplasia, one node was basal cell adenoma and the other node was fibrous connective tissue hyperplasia; the three patients without PLN metastases were excluded from further analyses. Among the remaining 37 patients, abnormal 18F-FDG uptake was observed in five lesions in four patients on PET/CT. The radiotherapy plans of these 37 patients were reviewed: 12 PLN lesions in ten patients had been included in the GTV or CTV receiving ≥54 Gy; all 37 patients also received chemotherapy. Three months after radiotherapy, 21 parotid lesions in 17/37 patients achieved CR, 4 lesions in 4 patients achieved PR, and 16 lesions in 16 patients achieved SD, while the primary tumor and cervical lymph nodes of these 37 patients all achieved CR or PR. Thus, 25 PLN metastases were identified in 21/1811 patients (Fig. 1); the incidence of PLN metastasis was 1.2%.


Prognostic value of parotid lymph node metastasis in patients with nasopharyngeal carcinoma receiving intensity-modulated radiotherapy.

Zhang Y, Li WF, Chen L, Mao YP, Guo R, Zhang F, Peng H, Liu LZ, Li L, Liu Q, Ma J - Sci Rep (2015)

Flowchart illustrating the identification of positive parotid lymph nodes.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4561956&req=5

f1: Flowchart illustrating the identification of positive parotid lymph nodes.
Mentions: Among the 1811 patients with NPC, 45 parotid nodules with size ≥5 mm were identified in 40 patients in follow-up MRI imaging. Of these 40 patients, only four underwent pretreatment FNAC: one node was a metastatic PLN, one node was reactive lymphoid hyperplasia, one node was basal cell adenoma and the other node was fibrous connective tissue hyperplasia; the three patients without PLN metastases were excluded from further analyses. Among the remaining 37 patients, abnormal 18F-FDG uptake was observed in five lesions in four patients on PET/CT. The radiotherapy plans of these 37 patients were reviewed: 12 PLN lesions in ten patients had been included in the GTV or CTV receiving ≥54 Gy; all 37 patients also received chemotherapy. Three months after radiotherapy, 21 parotid lesions in 17/37 patients achieved CR, 4 lesions in 4 patients achieved PR, and 16 lesions in 16 patients achieved SD, while the primary tumor and cervical lymph nodes of these 37 patients all achieved CR or PR. Thus, 25 PLN metastases were identified in 21/1811 patients (Fig. 1); the incidence of PLN metastasis was 1.2%.

Bottom Line: Ten of the 21 patients received irradiation of the involved PLNs; the PLN recurrence rate was significantly higher for patients who received no irradiation; thus only patients with irradiated PLN were included in prognostic analyses.PLN involvement had a significantly higher hazard ratio (HR) for distant failure than N2 disease and similar HR to N3 disease.In conclusion, PLN metastasis is rare in NPC and was associated with similarly poor DMFS as N3 disease.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China.

ABSTRACT
The prognostic value and staging category of parotid lymph node (PLN) metastasis in nasopharyngeal carcinoma (NPC) remain unknown. We retrospectively reviewed MRI scans and medical records for 1811 NPC patients who received intensity-modulated radiotherapy. The diagnosis of PLN metastasis was mainly based on MRI follow-up. Twenty-five positive PLNs in 21/1811 patients were identified; the incidence of PLN metastasis was 1.2%. PLN metastasis was significantly associated with advanced N-category and stage. Ten of the 21 patients received irradiation of the involved PLNs; the PLN recurrence rate was significantly higher for patients who received no irradiation; thus only patients with irradiated PLN were included in prognostic analyses. PLN metastasis was associated with significantly poorer progression-free survival, overall survival and distant metastasis-free survival (DMFS), but not regional or local relapse-free survival, in univariate analysis. In multivariate analysis, PLN metastasis was also significantly associated with poor DMFS. PLN involvement had a significantly higher hazard ratio (HR) for distant failure than N2 disease and similar HR to N3 disease. In conclusion, PLN metastasis is rare in NPC and was associated with similarly poor DMFS as N3 disease. PLN metastasis should be suspected in advanced nodal disease, but diagnosed with care before administering aggressive treatment.

No MeSH data available.


Related in: MedlinePlus