Delineation of reduced CTV2 on the basis of the characteristics and distribution of cervical lymph node metastasis in nasopharyngeal carcinoma
Abstract Introduction The core objective of this study was to precisely locate metastatic lymph nodes, identify potential areas in nasopharyngeal carcinoma patients that may not require radiotherapy, and propose a hypothesis for reduced target volume radiotherapy on the basis of these findings. Ulti...
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BMC
2025-01-01
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| Series: | BMC Cancer |
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| Online Access: | https://doi.org/10.1186/s12885-025-13498-1 |
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| author | Zhiqiang Wang Yi Yang Chunlei Ge Rui Tian Sheng Cheng Jingyu Gao Yan Wang Qi Yue Zhiwei Wang Qingqing He Yuchuan Xu Yan Li Xudong Feng Yanli Yang Yong Zhang |
| author_facet | Zhiqiang Wang Yi Yang Chunlei Ge Rui Tian Sheng Cheng Jingyu Gao Yan Wang Qi Yue Zhiwei Wang Qingqing He Yuchuan Xu Yan Li Xudong Feng Yanli Yang Yong Zhang |
| author_sort | Zhiqiang Wang |
| collection | DOAJ |
| description | Abstract Introduction The core objective of this study was to precisely locate metastatic lymph nodes, identify potential areas in nasopharyngeal carcinoma patients that may not require radiotherapy, and propose a hypothesis for reduced target volume radiotherapy on the basis of these findings. Ultimately, we reassessed the differences in dosimetry of organs at risk (OARs) between reduced target volume (reduced CTV2) radiotherapy and standard radiotherapy. Methods and materials A total of 209 patients participated in the study. We used image registration techniques to map patients’ neck metastatic lymph nodes onto a template CT of healthy individuals. Using MIM software, we integrated all patients’ lymph node images onto the template CT images and conducted an in-depth analysis of their distribution characteristics and metastatic patterns. Subsequently, we randomly selected the localization images of 30 patients and used paired t test methods to compare the differences in the dosimetry of target volumes and OARs between reduced target volume radiotherapy and standard radiotherapy. Results A total of 2314 metastatic lymph nodes were identified and mapped. There were no metastatic lymph nodes observed at level VIIb or within the lateral border of the common carotid artery. The percentages of metastatic lymph nodes at levels Ia, Ib, IIa, IIb, III, IVa, IVb, Va, Vb, Vc, VIa, VIb, VIIa, VIIb and VIII accounted for 0%, 1.5%, 22.8%, 41.1%, 15.9%, 3.0%, 0%, 4.4%, 1.0%, 0.3%, 0%, 0%, 9.7%, 0% and 0.3%, respectively, of the 2314 metastatic lymph nodes. Further analysis of the dosimetric outcomes revealed a significantly lower mean dose to the oral cavity, laryngeal cavity, esophagus, trachea, pharyngeal constrictor muscles, parotid gland, submandibular gland and thyroid gland with the implementation of reduced-target radiotherapy than with standard radiotherapy. Conclusion IMRT sparing level I, IVb, VI, and VIIb lymph nodes and the area within the lateral border of the common carotid artery for stage II-IVa NPC patients is feasible. This method can significantly reduce the dose to peripheral organs at risk. |
| format | Article |
| id | doaj-art-f755202bb2014cdcaa5ded6be20d77c4 |
| institution | Kabale University |
| issn | 1471-2407 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | BMC Cancer |
| spelling | doaj-art-f755202bb2014cdcaa5ded6be20d77c42025-01-26T12:38:03ZengBMCBMC Cancer1471-24072025-01-0125111010.1186/s12885-025-13498-1Delineation of reduced CTV2 on the basis of the characteristics and distribution of cervical lymph node metastasis in nasopharyngeal carcinomaZhiqiang Wang0Yi Yang1Chunlei Ge2Rui Tian3Sheng Cheng4Jingyu Gao5Yan Wang6Qi Yue7Zhiwei Wang8Qingqing He9Yuchuan Xu10Yan Li11Xudong Feng12Yanli Yang13Yong Zhang14Department of Radiation Oncology, First Affiliated Hospital of Kunming Medical UniversityDepartment of Oncology, The People’s Hospital of Baoshan CityDepartment of Cancer Biotherapy Center, The Third Affiliated Hospital of Kunming Medical University (Tumor Hospital of Yunnan Province)Department of Radiation Oncology, First Affiliated Hospital of Kunming Medical UniversityDepartment of 1st Otolaryngology, First Affiliated Hospital of Kunming Medical UniversityDepartment of 1st Otolaryngology, First Affiliated Hospital of Kunming Medical UniversityDepartment of 1st Otolaryngology, First Affiliated Hospital of Kunming Medical UniversityDepartment of Radiation Oncology, First Affiliated Hospital of Kunming Medical UniversityDepartment of Radiation Oncology, First Affiliated Hospital of Kunming Medical UniversityDepartment of Radiation Oncology, First Affiliated Hospital of Kunming Medical UniversityDepartment of Radiation Oncology, First Affiliated Hospital of Kunming Medical UniversityDepartment of Radiation Oncology, First Affiliated Hospital of Kunming Medical UniversityDepartment of Radiation Oncology, First Affiliated Hospital of Kunming Medical UniversityDepartment of 1st Otolaryngology, First Affiliated Hospital of Kunming Medical UniversityDepartment of Radiation Oncology, First Affiliated Hospital of Kunming Medical UniversityAbstract Introduction The core objective of this study was to precisely locate metastatic lymph nodes, identify potential areas in nasopharyngeal carcinoma patients that may not require radiotherapy, and propose a hypothesis for reduced target volume radiotherapy on the basis of these findings. Ultimately, we reassessed the differences in dosimetry of organs at risk (OARs) between reduced target volume (reduced CTV2) radiotherapy and standard radiotherapy. Methods and materials A total of 209 patients participated in the study. We used image registration techniques to map patients’ neck metastatic lymph nodes onto a template CT of healthy individuals. Using MIM software, we integrated all patients’ lymph node images onto the template CT images and conducted an in-depth analysis of their distribution characteristics and metastatic patterns. Subsequently, we randomly selected the localization images of 30 patients and used paired t test methods to compare the differences in the dosimetry of target volumes and OARs between reduced target volume radiotherapy and standard radiotherapy. Results A total of 2314 metastatic lymph nodes were identified and mapped. There were no metastatic lymph nodes observed at level VIIb or within the lateral border of the common carotid artery. The percentages of metastatic lymph nodes at levels Ia, Ib, IIa, IIb, III, IVa, IVb, Va, Vb, Vc, VIa, VIb, VIIa, VIIb and VIII accounted for 0%, 1.5%, 22.8%, 41.1%, 15.9%, 3.0%, 0%, 4.4%, 1.0%, 0.3%, 0%, 0%, 9.7%, 0% and 0.3%, respectively, of the 2314 metastatic lymph nodes. Further analysis of the dosimetric outcomes revealed a significantly lower mean dose to the oral cavity, laryngeal cavity, esophagus, trachea, pharyngeal constrictor muscles, parotid gland, submandibular gland and thyroid gland with the implementation of reduced-target radiotherapy than with standard radiotherapy. Conclusion IMRT sparing level I, IVb, VI, and VIIb lymph nodes and the area within the lateral border of the common carotid artery for stage II-IVa NPC patients is feasible. This method can significantly reduce the dose to peripheral organs at risk.https://doi.org/10.1186/s12885-025-13498-1Intensity-modulated radiation therapyNasopharyngeal carcinomaTarget optimizationDistribution of lymph node metastasisReduced CTV2 |
| spellingShingle | Zhiqiang Wang Yi Yang Chunlei Ge Rui Tian Sheng Cheng Jingyu Gao Yan Wang Qi Yue Zhiwei Wang Qingqing He Yuchuan Xu Yan Li Xudong Feng Yanli Yang Yong Zhang Delineation of reduced CTV2 on the basis of the characteristics and distribution of cervical lymph node metastasis in nasopharyngeal carcinoma BMC Cancer Intensity-modulated radiation therapy Nasopharyngeal carcinoma Target optimization Distribution of lymph node metastasis Reduced CTV2 |
| title | Delineation of reduced CTV2 on the basis of the characteristics and distribution of cervical lymph node metastasis in nasopharyngeal carcinoma |
| title_full | Delineation of reduced CTV2 on the basis of the characteristics and distribution of cervical lymph node metastasis in nasopharyngeal carcinoma |
| title_fullStr | Delineation of reduced CTV2 on the basis of the characteristics and distribution of cervical lymph node metastasis in nasopharyngeal carcinoma |
| title_full_unstemmed | Delineation of reduced CTV2 on the basis of the characteristics and distribution of cervical lymph node metastasis in nasopharyngeal carcinoma |
| title_short | Delineation of reduced CTV2 on the basis of the characteristics and distribution of cervical lymph node metastasis in nasopharyngeal carcinoma |
| title_sort | delineation of reduced ctv2 on the basis of the characteristics and distribution of cervical lymph node metastasis in nasopharyngeal carcinoma |
| topic | Intensity-modulated radiation therapy Nasopharyngeal carcinoma Target optimization Distribution of lymph node metastasis Reduced CTV2 |
| url | https://doi.org/10.1186/s12885-025-13498-1 |
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