Individualized Elective Neck Irradiation Based on MRI in NPC Patients
Condition: Nasopharyngeal Carcinoma
MeSH terms: Carcinoma; Nasopharyngeal Carcinoma
Study type: Interventional
Phase: Phase 3

Summary: 
      Currently, most protocols of nasopharyngeal carcinoma (NPC) of various research bodies such
      as the Radiation Therapy Oncology Group require routine elective irradiation to the
      retropharyngeal area and to levels II-V lymph nodal areas regardless of the status of nodal
      metastasis. Previous studies had confirmed that the pattern of cervical lymph node (LN)
      metastasis in NPC followed an orderly manner. Retropharyngeal LNs were the most commonly
      involved, followed by upper neck levels II, III, or VA nodes, and finally to the lower neck
      nodes including level IV and VB nodes; and the incidence of LN skip metastasis is rare,
      ranging from 0.5% to 7.9%. It was rare for NPC patients without neck LN metastases to
      experience neck failure after elective irradiation to levels II, III and VA. It was also
      confirmed that with unilateral LN metastases of higher-level LNs usually spread down
      ipsilateral LNs. Thus, the investigators conduct the non-inferior randomized trial to
      determine the value of elective neck irradiation in NPC patients with unilateral or bilateral
      uninvolved neck.
    

Detailed description: 
      Currently, most protocols of nasopharyngeal carcinoma (NPC) of various research bodies such
      as the Radiation Therapy Oncology Group require routine elective irradiation to the
      retropharyngeal area and to levels II-V lymph nodal areas regardless of the status of nodal
      metastasis. Previous studies had confirmed that the pattern of cervical lymph node (LN)
      metastasis in NPC followed an orderly manner. Retropharyngeal LNs were the most commonly
      involved, followed by upper neck levels II, III, or VA nodes, and finally to the lower neck
      nodes including level IV and VB nodes; and the incidence of LN skip metastasis is rare,
      ranging from 0.5% to 7.9%. It was rare for NPC patients without neck LN metastases to
      experience neck failure after elective irradiation to levels II, III and VA. It was also
      confirmed that with unilateral LN metastases of higher-level LNs usually spread down
      ipsilateral LNs. Thus, the investigators conduct the non-inferior randomized trial to
      determine the value of elective neck irradiation in NPC patients with unilateral or bilateral
      uninvolved neck.
    

Intervention name(s): Elective neck irradiation; Whole neck irradiation
Intervention type(s): Radiation; Radiation
Intervention description(s): Whole neck irradiation is given in the involved neck. Elective neck irradiation of Level II,III and Va lymph node area is given in the uninvolved neck, and Level IV and Vb lymph node area were not irradiated in the uninvolved neck.; Whole neck irradiation is given regardless of the involved or uninvolved neck.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: nasopharyngeal carcinoma; elective neck irradiation; upper neck irradiation; whole neck irradiation