Contemporary management of the neck in nasopharyngeal carcinoma

Wai Tong Ng; Raymond K Y Tsang; Jonathan J Beitler; Remco de Bree; Andrés Coca-Pelaz; Avraham Eisbruch; Orlando Guntinas-Lichius; Anne W M Lee; Antti A Mäkitie; William M Mendenhall; Sandra Nuyts; Alessandra Rinaldo; K Thomas Robbins; Juan P Rodrigo; Carl E Silver; Ricard Simo; Robert Smee; Primož Strojan; Robert P Takes; Alfio Ferlito

doi:10.1002/hed.26685

Contemporary management of the neck in nasopharyngeal carcinoma

Head Neck. 2021 Jun;43(6):1949-1963. doi: 10.1002/hed.26685. Epub 2021 Mar 29.

Authors

Wai Tong Ng¹, Raymond K Y Tsang², Jonathan J Beitler^{3

4

5}, Remco de Bree⁶, Andrés Coca-Pelaz^{7

8}, Avraham Eisbruch⁹, Orlando Guntinas-Lichius¹⁰, Anne W M Lee^{1

11}, Antti A Mäkitie^{12

13

14}, William M Mendenhall¹⁵, Sandra Nuyts^{16

17}, Alessandra Rinaldo¹⁸, K Thomas Robbins¹⁹, Juan P Rodrigo^{7

8}, Carl E Silver²⁰, Ricard Simo²¹, Robert Smee²², Primož Strojan²³, Robert P Takes²⁴, Alfio Ferlito²⁵

Affiliations

¹ Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
² Department of Otorhinolaryngology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
³ Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.
⁴ Department of Otolaryngology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.
⁵ Department of Hematology/Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.
⁶ Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
⁷ Department of Otolaryngology, Hospital Universitario Central de Asturias-University of Oviedo, Oviedo, Spain.
⁸ Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Spain.
⁹ Department of Radiation Oncology, University of Michigan Medicine, Ann Arbor, Michigan, USA.
¹⁰ Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.
¹¹ Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
¹² Department of Otorhinolaryngology-Head and Neck Surgery, HUS Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
¹³ Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
¹⁴ Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
¹⁵ Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA.
¹⁶ Department of Radiation Oncology, University Hospitals Leuven, KU Leuven - University of Leuven, Leuven, Belgium.
¹⁷ Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium.
¹⁸ Department of Otolaryngology, University of Udine School of Medicine, Udine, Italy.
¹⁹ Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University Medical School, Springfield, Illinois, USA.
²⁰ Department of Surgery, University of Arizona College of Medicine, Phoenix, Arizona, USA.
²¹ Departement of Otorhinolaryngology, Head and Neck Surgery, Head and Neck and Thyroid Oncology Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.
²² Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, New South Wales, Australia.
²³ Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia.
²⁴ Department of Otolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
²⁵ International Head and Neck Scientific Group, Padua, Italy.

PMID: 33780074
DOI: 10.1002/hed.26685

Abstract

Up to 85% of the patients with nasopharyngeal carcinoma present with regional nodal metastasis. Although excellent nodal control is achieved with radiotherapy, a thorough understanding of the current TNM staging criteria and pattern of nodal spread is essential to optimize target delineation and minimize unnecessary irradiation to adjacent normal tissue. Selective nodal irradiation with sparing of the lower neck and submandibular region according to individual nodal risk is now emerging as the preferred treatment option. There has also been continual refinement in staging classification by incorporating relevant adverse nodal features. As for the uncommon occurrence of recurrent nodal metastasis after radiotherapy, surgery remains the standard of care.

Keywords: nasopharyngeal carcinoma; nodal metastasis; prognosis; radiotherapy; staging; surgery.

Publication types

Review

MeSH terms

Carcinoma* / therapy
Humans
Lymphatic Metastasis
Nasopharyngeal Carcinoma / radiotherapy
Nasopharyngeal Neoplasms* / pathology
Nasopharyngeal Neoplasms* / radiotherapy
Neck / pathology
Neoplasm Staging