Nasopharyngeal carcinoma (NPC)—issues in the inclusion of cervical nodal region in radiation treatment volume

Free AccessLetter to the editorNasopharyngeal carcinoma (NPC)—issues in the inclusion of cervical nodal region in radiation treatment volumeBilal M Qureshi, Ahmed N Abbasi, Nasir Ali and Asim HafizBilal M Qureshihttp://orcid.org/0000-0002-0138-7628Section of Radiation Oncology, Department of Oncology, Aga Khan University, Karachi, PakistanSearch for more papers by this author, Ahmed N AbbasiSection of Radiation Oncology, Department of Oncology, Aga Khan University, Karachi, PakistanSearch for more papers by this author, Nasir AliSection of Radiation Oncology, Department of Oncology, Aga Khan University, Karachi, PakistanSearch for more papers by this author and Asim HafizSection of Radiation Oncology, Department of Oncology, Aga Khan University, Karachi, PakistanSearch for more papers by this authorPublished Online:25 Nov 2016https://doi.org/10.1259/bjr.20160726SectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail AboutTo the Editor,Nasopharyngeal carcinoma (NPC) is a common tumour of this part of the world and radiation treatment planning is always a challenging task. Our team has gone through the study by Li et al1 with interest. We are in agreement with the authors with respect to the technique and specification of external beam radiation treatment offered to the patients mentioned in this study. We would like to raise our difference of opinion related to inclusion of nodal regions in intensity-modulated radiation therapy high dose volumes. In our practice, the distribution of nodal involvement varies from Level 1 to Level 5 in such an unpredictable manner that we intend to include all nodal regions in our Phase 2 volumes.2 This fact is being observed in various other studies.3We would like to request the authors to share with the readers of British Journal of Radiology their study data pertaining to patterns of nodal failures with further stratification mentioning any possibility of a confounding variable playing any role in this pattern. It would be a useful information for the readers if the authors can share with us their experience of including Level Ib lymph node in initial volume and toxicity related to it.Since we are using intensity-modulated radiation therapy as the basic planning modality in all radical NPC cases, we are not encountering any higher grade cutaneous adverse effects. At the moment, in our clinical practice, our team feels more comfortable in including all levels of cervical lymph nodal chains in the first phase of our volume. Nodal status in NPC is an independent prognostic factor; therefore, we are quite keen to know author views regarding balancing some added tolerable minimal iatrogenic side effects of radiation if we decide to carry on with our practice of inclusion of all nodal levels in our target volumes.4REFERENCES1 Li M, , Huang XG, , Yang ZN, , Lu JY, , Zhan YZ, , Xie WJ, et al.. Effects of omitting elective neck irradiation to nodal Level IB in nasopharyngeal carcinoma patients with negative Level IB lymph nodes treated by intensity-modulated radiotherapy: a Phase 2 study. Br J Radiol 2016; 89: 20150621. doi: https://doi.org/10.1259/bjr.20150621 Link ISI, Google Scholar2 Abbasi AN, , Hafiz A, , Ali N, , Khan KA. Plan dose evaluation of three dimensional conformal radiotherapy planning (3D-CRT) of nasopharyngeal carcinoma (NPC): experience of a tertiary care University Hospital in Pakistan. Asian Pac J Cancer Prev 2013; 14: 5989–93. Crossref Medline, Google Scholar3 Wang M, , Xu Y, , Chen X, , Chen H, , Gong H, , Chen S. Prognostic significance of residual or recurrent lymph nodes in the neck for patients with nasopharyngeal carcinoma after radiotherapy. J Cancer Res Ther 2016; 12: 909–14. doi: https://doi.org/10.4103/0973-1482.168969 Crossref Medline ISI, Google Scholar4 Abbasi AN, , Zahid S, , Bhurgri Y, , Ali N, , Karsan F. Nasopharyngeal carcinoma—an update of treatment and acute radiation induced reactions from a tertiary-care hospital in Pakistan. Asian Pac J Cancer Prev 2011; 12: 735–8. Medline, Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 90, Issue 1069January 2017 © 2016 The Authors. Published by the British Institute of Radiology History ReceivedAugust 30,2016AcceptedOctober 17,2016Published onlineNovember 25,2016 Metrics Download PDF