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Selective neck irradiation for supraglottic cancer: focus on Sublevel IIb omission
Naoyuki Kanayama1, Kinji Nishiyama2, Yoshifumi Kawaguchi3
1Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka naoyukikana@gmail.com.
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.
