Selective neck irradiation for supraglottic cancer: focus on Sublevel IIb omission.

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Selective neck irradiation for supraglottic cancer: focus on Sublevel IIb omission.

Jpn J Clin Oncol. 2016 Jan;46(1):51-6

Authors: Kanayama N, Nishiyama K, Kawaguchi Y, Konishi K, Ogawa K, Suzuki M, Yoshii T, Fujii T, Yoshino K, Teshima T

Abstract
OBJECTIVE: To estimate selective neck irradiation omitting surgical Sublevel IIb.
METHODS: Bilateral necks of 47 patients (94 necks) were subjected to definitive radiotherapy for supraglottic cancer. Sixty-nine and 25 necks were clinically node negative (cN-) and clinically node positive (cN+), respectively. We subdivided Sublevel IIb by the international consensus guideline for radiotherapy into Sublevel IIb/a, directly posterior to the internal jugular vein, and Sublevel IIb/b, which was behind Sublevel IIb/a and coincided with surgical Sublevel IIb. Bilateral (Sub)levels IIa, III, IV and IIb/a were routinely irradiated, whereas Sublevel IIb/b was omitted from the elective clinical target volume in 73/94 treated necks (78%).
RESULTS: Two patients presented with ipsilateral Sublevel IIb/a metastases. No Sublevel IIb/b metastasis was observed. Five patients experienced cervical lymph node recurrence; Sublevel IIb/a recurrence developed in two patients, whereas no Sublevel IIb/b recurrence occurred even in the cN- necks of cN+ patients or cN0 patients. The 5-year regional control rates were 91.5% for Sublevel IIb/b-omitted patients and 77.8% for Sublevel IIb/b treated patients.
CONCLUSIONS: Selective neck irradiation omitting Sublevel IIb/b did not compromise regional control and could be indicated for cN- neck of supraglottic cancer.

PMID: 26491205 [PubMed - indexed for MEDLINE]

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