American Association for Cancer Research
ccr-23-3274_supplementary_figure_2_suppfs2.pdf (20.99 kB)

Supplementary Figure 2 from Optimizing Cervical Target Volume in Patients with Nasopharyngeal Cancer Based On Nodal Drainage Distance

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journal contribution
posted on 2024-05-01, 07:21 authored by Yang Liu, Wenbin Yan, Chaosu Hu, Xiaodong Huang, Kai Wang, Yuan Qu, Xuesong Chen, Runye Wu, Ye Zhang, Jianghu Zhang, Jingwei Luo, Yexiong Li, Jingbo Wang, Junlin Yi

The number and percentage of caudally located LNs included in each maximum diameter (MD) range.


National High Level Hospital Clinical Research Funding

Chinese Academy of Medical Sciences Initiative for Innovative Medicine (中国医学科学院创新工程)

Beijing hope run fund



To determine the potential nodal drainage distances of nasopharyngeal carcinoma (NPC) by investigating spatial distribution of metastatic lymph nodes (LN). Patients with NPC harboring at least two ipsilateral metastatic LNs were enrolled. LN spreading distances were analyzed in nonrestricted direction, cranial-to-caudal direction, and between the two most caudal LNs. Euclidean distance (ED) and vertical distance (VD) between any two LNs were computed. The nearest-neighbor ED and VD covering 95% of LNs or patients (p95-ED and p95-VD) were considered drainage distances, and were further validated by independent internal and external cohorts with recurrent LNs. In all, 5,836 metastatic LNs in 948 patients were contoured. Corresponding to the three scenarios, per-LN level, the p95-EDs were 2.83, 3.28, and 3.55 cm, and p95-VDs were 2.17, 2.32, and 2.63 cm, respectively. Per-patient level, the p95-EDs were 3.25, 3.95, and 3.81 cm, and p95-VDs were 2.67, 2.81, and 2.73 cm, respectively. In internal validation, over 95% of recurred LNs occurred within ED of 2.91 cm and VD of 0.82 cm to the neighbor LN, and the corresponding distances in external validation were 2.77 and 0.67 cm, respectively. In NPC, the maximum LN drainage distance was 3.95 cm without considering the direction. Specifically, in cranial-to-caudal direction, the sufficient vertical drainage distance was 2.81 cm, indicating that a 3-cm extension from the most inferior node may be rational as caudal border of the prophylactic clinical target volume (CTV). These findings promote in-depth understanding of nodal spreading patterns, uncovering paramount evidence for individualized CTV.