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Management of Extensive Cervical Nodal Metastasis in Nasopharyngeal Carcinoma After Radiotherapy
A Clinicopathological Study
William Ignace Wei, FRCS;
Wai Kuen Ho, FRCSE;
Ashley C. K. Cheng, FRCR;
Xiaoqing Wu, MBBS;
George K. H. Li, FRCS;
John Nicholls, FRCPA;
Po Wing Yuen, FRCSE;
Jonathan Shun Tong Sham, FRCR
Arch Otolaryngol Head Neck Surg. 2001;127:1457-1462.
Objectives To evaluate the efficacy of afterloading brachytherapy following radical
neck dissection (RND) in the management of extensive cervical lymph node disease
in nasopharyngeal carcinoma after radiotherapy; and to examine prospectively
prognostic factors and the pathologic behavior of neck disease.
Patients Twenty-seven patients with nasopharyngeal carcinoma who had extensive
cervical lymph node metastasis following external radiotherapy were treated
with RND. Thirteen of them also underwent afterloading brachytherapy with
iridium wire (Ir 192). The RND specimens of the 27 patients were also examined
with step serial whole-specimen sectioning.
Results All patients survived and their wounds healed primarily. Pathologic
examination revealed 183 tumor-bearing lymph nodes that contained tumors in
the neck: level I, 4% (8/183); level II, 53% (96/183); level III, 34% (62/183);
level IV, 5% (9/183); and level V, 4% (8/183). Extracapsular tumor extension
was seen in 84% of patients. Multivariate analysis identified the number of
tumor-bearing lymph nodes detected in the specimens to be the only significant
factor that affected control of disease. Although the neck disease in the
group of patients who had afterloading brachytherapy was more extensive, the
3-year actuarial tumor control for the groups with and without brachytherapy
were 60% and 61%, respectively.
Conclusions Recurrent cervical lymph nodes after radiotherapy in nasopharyngeal
carcinoma are extensive and RND is mandatory for a successful salvage. When
the nodal metastasis infiltrate or adhere to surrounding tissue, afterloading
brachytherapy with iridium wire can provide satisfactory local tumor control.
From the Departments of Surgery (Drs Wei, Ho, Li, and Yuen and Mr Wu),
Clinical Oncology (Drs Cheng and Sham), and Pathology (Dr Nicholls), University
of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong.
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