Proposals for the delineation of neck clinical target volume for definitive Radiation therapy in patients with oral/ oropharyngeal squamous cell cancer based on lymph node distribution.

Autor: Liu YC; College of Medicine, Chongqing University, Chongqing, China. Electronic address: liuyunchang1010@163.com., Zhang X; Radiation Oncology Center, Chongqing University Cancer Hospital, Chongqing, China. Electronic address: zhangxin9964@cqu.edu.cn., Yang HN; College of Medicine, Chongqing University, Chongqing, China., Zhang L; College of Medicine, Chongqing University, Chongqing, China., Li D; Radiation Oncology Center, Chongqing University Cancer Hospital, Chongqing, China., Yang MQ; Radiation Oncology Center, Chongqing University Cancer Hospital, Chongqing, China., Wang NH; College of Medicine, Chongqing University, Chongqing, China., Wu YZ; College of Medicine, Chongqing University, Chongqing, China; Radiation Oncology Center, Chongqing University Cancer Hospital, Chongqing, China., Sui JD; College of Medicine, Chongqing University, Chongqing, China; Radiation Oncology Center, Chongqing University Cancer Hospital, Chongqing, China. Electronic address: jiangdong.sui@cqu.edu.cn., Wang Y; College of Medicine, Chongqing University, Chongqing, China; Radiation Oncology Center, Chongqing University Cancer Hospital, Chongqing, China. Electronic address: wangy123@cqu.edu.cn.
Jazyk: angličtina
Zdroj: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology [Radiother Oncol] 2024 Jun; Vol. 195, pp. 110225. Date of Electronic Publication: 2024 Mar 14.
DOI: 10.1016/j.radonc.2024.110225
Abstrakt: Purpose/objective(s): To establish the distribution pattern of cervical lymph node metastasis (LNM) and propose optimized clinical target volume (CTV) boundaries specific to oral/ oropharyngeal squamous cell cancer (OSCC/OPSCC).
Materials/methods: 531 patients with pathologically confirmed OSCC/OPSCC were enrolled from January 2013 to June 2022. Patients were stratified into two groups based on the minimal distance from the lesion's edge to the body's midline: ≤1 cm or > 1 cm. The geometric center of cervical metastatic LN was marked on a template CT. LN distribution probability maps were established. The relationships between the LN distribution and consensus guidelines were analyzed to propose modifications for CTV boundaries specific to OSCC/OPSCC.
Results: A total of 1962 positive LNs were enrolled. Compared with the > 1 cm group, the ≤ 1 cm group has following feature tendencies: male smokers, younger, median organs, large gross lesion, infiltrative growth pattern, contralateral LNM. The most frequently involved level of LNM was ipsilateral II, but ipsilateral Ib had the highest involvement rate in the > 1 cm OSCC group. In addition, tongue cancer had a higher incidence of LN extranodal extension (ENE), which mainly distributes in ipsilateral level II. The skip metastasis was prone to from level III to Vb (3.5 %) in LN(+)/ENE (-), and level Ib to VIa (3.7 %) in LN(+)/ENE (+). Accordingly, we proposed the following modifications: 1. only including lateral and posterior margin of submandibular gland within 5 mm; 2. retracting posterior boundary of level II to front edge of levator scapula muscle, and descending the upper boundary to transverse process of C2 vertebra only for OSCC; 3. including posterior third of thyroglossal muscle or anterior edge of sternocleidomastoid muscle; 4. sparing level Va in case of only level II involvement; 5. including upper area of the thyroid cartilage plate in case of level Ib LN(+)/ENE (+); 6. sparing level VIIa is considered.
Conclusion: This is the first description of LN topographic spread patterns for OSCC/OPSCC. Modified CTV for prophylactic irradiation was proposed to spare the organs at risk and minimize adverse effects.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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