Management of the node-negative neck in early-stage nasopharyngeal carcinoma

Abstract

Summary Nasopharyngeal carcinoma (NPC) has always been treated definitively via radiation, either as a single modality in early stage or with concurrent chemotherapy in locally advanced disease [1]. In the treatment of early-stage NPC, the standard of care has traditionally been empirical irradiation to the bilateral whole neck, but, awkwardly, without clinical evidence backing such practice. Several retrospective studies and a recently published meta-analysis have shown that level I cervical lymph nodes and lower-neck lymph nodes possess a lower probability of disease involvement for NPC patients at presentation. This, coupled with the fact that skip metastasis only occurs rarely in NPC, have formed the basis of sparing these lymph nodes in the definitive irradiation of early-stage NPC patients.