2021-08-02 20:22:48
Journal Scan – This Month in Other Journals, August 2021
https://www.ajnrblog.org/2021/08/02/journal-scan-this-month-in-other-journals-august-2021/
1. Ng WT, Tsang RKY, Beitler JJ, et al. Contemporary management of the neck in nasopharyngeal carcinoma. Head Neck 2021;43:1949–63. Available from: https://onlinelibrary.wiley.com/doi/10.1002/hed.26685
For patients who present with suspicious cervical lymphadenopathy, especially in the endemic regions where NPC is prevalent, initial examination may be endoscopic examination and biopsy of the NP, rather than fine-needle aspiration of the neck mass. Subsequent work up includes appropriate biopsy of the primary tumor and/or the node, physical examination with particular attention to cranial nerve function, plasma Epstein–Barr virus (EBV) DNA, CT scanning, MR, and FDG-PET. Radiotherapy with or without chemotherapy remains the primary modality of treatment, while surgery is reserved for persistent nodal disease or relapse.
With improvement in radiological diagnostic accuracy and better characterization of the natural history of NPC nodal spread, continual refinements have been suggested in the AJCC/UICC TNM staging system. Among the various nodal features, recent data suggest that nodal volume, ECE, nodal necrosis, and parotid node involvement carry adverse prognostic significance. Selective nodal irradiation according to individual nodal risk has been increasingly adopted, and early data based on this approach appear promising. Furthermore, gradient dose prescription using a lower dose elective nodal irradiation (ENI) to subclinical regions may serve a potentially useful strategy for dose de-escalation with the objective of reducing toxicity and improving quality of life. Amidst excellent nodal control with IMRT, salvage neck surgery remains the standard of care for patients who develop nodal failure, and continued research is required to define the extent of neck dissection and the role of adjuvant therapy after salvage neck surgery.
4 tables, 1 figure
2. Sabiq F, Huang K, Patel A, et al. Novel imaging classification system of nodal disease in human papillomavirus‐mediated oropharyngeal squamous cell carcinoma prognostic of patient outcomes. Head Neck 2021;43:1854–63. Available from: https://onlinelibrary.wiley.com/doi/10.1002/hed.26657
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