The pattern of nodal recurrence following definitive radiotherapy for nasopharyngeal carcinoma

Background: The pattern of nodal metastasis in previously untreated nasopha ryngeal carcinoma (NPC) has been studied and reported. Tn order to analyse the pattern of recurrent nodal disease in previously heated NPC, a retrospe ctive study on 68 patients who underwent radical neck dissection for region ally recurrent NPC was conducted. Methods: Seventy-four neck dissections were performed on 68 patients who de veloped nodal recurrence after a mean disease-free interval of 39.2 months. None of the patients had evidence of local or systemic disease at the time of surgery. Histopathological reports of the 74 neck dissections were anal ysed with regard to the number of positive nodes as well as the number of i nvolved nodal levels. Results: Of the 65 neck dissection specimens with analysable data,31 showed metastatic disease at a single nodal level with a mean number of positive nodes of 1.2, while 34 showed metastatic disease at multiple levels with a mean number of positive nodes of 6.6. Nodal recurrence occurred at level II with the greatest frequency (78.5%). Of the 31 specimens with single level nodal involvement, 21 (67.7%) occurred at level Il. Isolated involvement a t the other levels did occur, but was uncommon (range 3-16%). Of the 34 spe cimens with multiple level nodal involvement, 30 (88.2%) showed involvement at level II. Once more than one level was involved, the frequency of invol vement at any given level was at least 30%. Conclusion: The predominant involvement at level ii and the high frequencie s of involvement at all levels support the use of a classical radical neck dissection in treating recurrent nodal disease in NPC.