William I Wei1, Vivian W K Mok. 1. Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong. hrmswwi@hkucc.hku.hk
Abstract
PURPOSE OF REVIEW: The management of cervical lymph node metastases in nasopharyngeal carcinoma is important for a favourable outcome. The strategy of diagnosis and treatment for the lymph nodes on presentation and those that have recurred after initial therapy are different. This review presents the current concept. RECENT FINDINGS: The detection of the cervical lymph node metastases on presentation has improved with magnetic resonance imaging and positron emission tomography. The confirmation of the presence of malignancy is through fine needle aspiration cytology. For those lymph nodes that have recurred after concurrent radiotherapy and chemotherapy, the progression of the nodes detected through clinical examination and imaging studies indicates that salvage therapy is necessary. The surgical procedure of salvage is radical neck dissection, as pathological studies have shown that these lymph nodes exhibit extensive involvement of the neck tissue. Postoperative brachytherapy should be applied when the deep resection margins are close. SUMMARY: Identification of lymph node metastasis provides accurate staging of the disease and radical surgery should be performed for salvage.
PURPOSE OF REVIEW: The management of cervical lymph node metastases in nasopharyngeal carcinoma is important for a favourable outcome. The strategy of diagnosis and treatment for the lymph nodes on presentation and those that have recurred after initial therapy are different. This review presents the current concept. RECENT FINDINGS: The detection of the cervical lymph node metastases on presentation has improved with magnetic resonance imaging and positron emission tomography. The confirmation of the presence of malignancy is through fine needle aspiration cytology. For those lymph nodes that have recurred after concurrent radiotherapy and chemotherapy, the progression of the nodes detected through clinical examination and imaging studies indicates that salvage therapy is necessary. The surgical procedure of salvage is radical neck dissection, as pathological studies have shown that these lymph nodes exhibit extensive involvement of the neck tissue. Postoperative brachytherapy should be applied when the deep resection margins are close. SUMMARY: Identification of lymph node metastasis provides accurate staging of the disease and radical surgery should be performed for salvage.