Patterns of level II node metastasis in nasopharyngeal carcinoma

Wang, XiaoShen; Li, LongGen; Hu, ChaoSu; Zhou, ZhengRong; Ying, HongMei; Ding, JianHui; Feng, Yan

doi:10.1016/j.radonc.2008.07.014

« Previous Next »Radiotherapy & Oncology
Volume 89, Issue 1 , Pages 28-32, October 2008

Patterns of level II node metastasis in nasopharyngeal carcinoma

XiaoShen Wang
- Department of Radiation Oncology, Fudan University, Shanghai, People’s Republic of China
LongGen Li
- Department of Radiation Oncology, Fudan University, Shanghai, People’s Republic of China
ChaoSu Hu
- Department of Radiation Oncology, Fudan University, Shanghai, People’s Republic of China
- Corresponding author. ChaoSu Hu, Department of Radiation Oncology, Cancer Hospital, Fudan University, 270 Dong’an Road, Shanghai 200032, People’s Republic of China
ZhengRong Zhou
- Department of Diagnostic Radiology, Fudan University, Shanghai, People’s Republic of China
HongMei Ying
- Department of Radiation Oncology, Fudan University, Shanghai, People’s Republic of China
JianHui Ding
- Department of Diagnostic Radiology, Fudan University, Shanghai, People’s Republic of China
Yan Feng
- Department of Radiation Oncology, Fudan University, Shanghai, People’s Republic of China

Received 3 May 2008; received in revised form 27 June 2008; accepted 16 July 2008. published online 03 September 2008.

Abstract

Purpose

To explore the pattern of metastasis to level II nodes and its relationship with tumor range in nasopharyngeal carcinoma (NPC) patients by using magnetic resonance imaging.

Methods and materials

Magnetic resonance images of 618 NPC patients were reviewed. Nodes were classified as metastatic based on size criteria, the presence of nodal necrosis, and extracapsular spread.

Results

Patients (87.9%, 543) had lymphadenopathy, 470 (86.5%) in level IIb and 326 (60.0%) in level IIa, respectively. Incidence of RLN involvement was less than that of level IIb node involvement (72.2% vs. 86.5%) in 543 patients with lymphadenopathy. Cranial boundaries (71.1%) of level IIb nodes was below the caudal border of C1, and 5.1% was below the skull base, while all the cranial boundaries of level IIa nodes were below the caudal edge of C1. Incidence of level IIb and/or level IIa node metastasis had no correlation with primary tumor extension. Incidence of level IIb metastasis did not differ significantly among T1, 2, 3, and 4 disease, nor did that of level IIa node.

Conclusions

Cervical level IIb nodes were the most commonly involved nodes in NPC. Metastasis to level IIb and level IIa nodes had no correlation with primary tumor extension, or with T stage. Setting the cranial border of level IIb node at the skull base should be considered when delineating nodal target volume.

Keywords: Nasopharyngeal carcinoma, Level II lymph node, Magnetic resonance imaging, Radiotherapy