![]() While the Guidelines are proposed for all head and neck cancers, NPCs are characterized by distinct lymph node metastasis patterns and merit a specific definition of lymph node CTVs. The current delineation protocol is mainly based on DAHANCA, EORTC, GORTEC, RTOG consensus guidelines (hereafter referred to as Guidelines), which suggest CT-based delineation of lymph node volumes on the basis of lymph node anatomy and surgical findings from N0 patients. At present, the definition of the clinical target volume (CTV) of cervical lymph node in NPC is still in debate. However, certain complications including acute radiation-induced mucositis, swallowing pain, radiation-induced skin injury are still prominent, probably because a part of the cervical lymph node target volumes are larger. Besides substantial efficacy improvement, IMRT also reduces some of the normal tissue complications such as mouth restriction, xerostomia, radiation-induced brain injury. With the development of modern radiotherapy equipments, treatment planning systems and the application of intensity-modulated radiation therapy (IMRT), the 5-year survival rate of NPC has increased from 50% in the 1970s to 80% in the 2000s. Radiotherapy is the predominant treatment modality. Nasopharyngeal carcinoma (NPC) is one of the most common malignant tumors in south China. Our recommendations might adequately encompass metastatic lymph nodes while sparing the organs at risk and reducing adverse events. the space of the posterior edge of trapezius muscle also should be included if there are metastatic lymph nodes in the transverse cervical vessle plexus. the anterior border of Level III and IV should gradually shift backwards and the CTV only include part of the cervical vessels below the level where the thyroid gland appears 5. Level II should include the posterior belly of digastric muscle, and the space between the posterior edge of submandibular gland and the anterior edge of sternocleidomastoid muscle 4. the submandibular gland should not be included in Level Ib 3. the lateral border of RLNs clinical target volume (CTV) be the medial edge of the internal carotid artery above the level of mastoid process, the medial border be adjacent to the cervical vessels below the free edge of the soft palate 2. Based on their distribution profile, we proposed the following modifications: 1. The proportions of retropharyngeal lymph nodes (RLNs), Level Ib, II, III, IV, Va, Vb and supraclavicular (SCV) lymph nodes were 6.9%, 0.5%, 55.25%, 20.4%, 8.2%, 4.9%, 3.1% and 0.75%, respectively. All lymph nodes were mapped into simulation computed tomography images of a template lymph node negative patient. ![]() ![]() In order to minimize cervical lymph node irradiation volume, 379 NPC patients with metastatic cervical lymph nodes were eligible for geographic mapping. Nasopharyngeal carcinoma (NPC) are characterized by distinct lymph node metastasis patterns. Received: AugAccepted: OctoPublished: June 05, 2018 Yahua Zhong, email: nasopharyngeal carcinoma intensity-modulated radiation therapy cervical lymph node clinical target volume Li Li 1, 2, Yi Li 1, 2, Jun Zhang 1, 2, Qiuji Wu 1, 2, Haijun Yu 1, 2, Zheng Li 1, 2, Conghua Xie 1, 2, Yunfeng Zhou 1, 2 and Yahua Zhong 1, 2ġDepartment of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, ChinaĢHubei Cancer Clinical Study Center, Wuhan University, Wuhan, Hubei, China ![]()
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