Prophylactic Lower Neck Radiation Not Necessary in Nasopharyngeal Cancer

For patients with nasopharyngeal cancer (NPC) that has not spread to the lymph nodes (node-negative ), prophylactic radiation to the upper neck provides the same effectiveness as radiation to the entire neck. These results were recently published in the journal Cancer.

Nasopharyngeal carcinoma is a type of cancer classified as a head and neck cancer. It refers to cancer that originates in the nasal and pharyngeal (upper throat) area of the head.

Treatment for node-negative NPC typically includes radiation therapy to the neck. Unfortunately, side effects from radiation therapy can significantly reduce quality of life for patients, so physicians and researchers continue to explore optimal ways to use radiation therapy to reduce the risks of a recurrence but maintain quality of life for these patients.

Researchers recently conducted a clinical trial to evaluate the use of prophylactic radiation to different areas of the neck in terms of effectiveness. The trial included 301 patients with node-negative NPC who received prophylactic radiation either to the entire neck, or just the upper neck.

After 3 years (median follow-up of 39 months), no patient, in either group, had a recurrence of cancer in the cervical (neck) lymph nodes.
Overall survival was 89.5% in patients who received radiation to the upper neck, and 87.4% for those who received radiation to the entire neck.
The rate of overall metastases was also similar between the two groups (8.3% for those treated with upper neck radiation and 9.1% for those treated with whole neck radiation).
The researchers concluded that “Prophylactic upper neck irradiation is sufficient for patients with node-negative NPC”.

Reference: Li J-G, Yuan X, Zhang L-L, et al. A randomized clinical trial comparing prophylactic upper versus whole-neck irradiation in the treatment of patients with node-negative nasopharyngeal carcinoma. Cancer. 2013;119(17):3170-3176.