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@ARTICLE{Looman:306676,
      author       = {E. L. Looman and T. W. H. van Zon-Meijer and A. Rühle$^*$
                      and H. Schäfer$^*$ and R. Ludwig and Y. P. Haas and J. A.
                      Langendijk and M. Guckenberger and P. Balermpas and J.
                      Unkelbach},
      title        = {{P}atterns of lymphatic spread in hypopharyngeal squamous
                      cell carcinoma - {F}indings from a multicenter study.},
      journal      = {Radiotherapy and oncology},
      volume       = {nn},
      issn         = {0167-8140},
      address      = {Amsterdam [u.a.]},
      publisher    = {Elsevier Science},
      reportid     = {DKFZ-2025-02669},
      pages        = {nn},
      year         = {2025},
      note         = {epub},
      abstract     = {Aiming for personalization of the elective nodal
                      irradiation (ENI) in hypopharyngeal squamous cell carcinoma
                      (SCC) patients, we describe the regional lymphatic spread
                      patterns and risk of lymph node metastases, considering not
                      only T-stage, location and lateralization of the primary
                      tumor, but also involvement of adjacent lymph node levels
                      (LNLs).Patients with newly diagnosed hypopharyngeal SCC
                      diagnosed at University Hospital Zurich between 2013-2021,
                      UMCG Groningen between 2006-2023 and University Medical
                      Center Freiburg between 2011-2019 were analyzed. Lymphatic
                      involvement per level was assessed based on imaging and, if
                      available, pathology. The dataset is made publicly available
                      and can be visualized on https://lyprox.org/.390 patients
                      with hypopharyngeal SCC were included, 81 $\%$ had one or
                      more cervical lymph node metastases. Overall prevalence of
                      involvement in LNLs II, III, IV, V was consistent with
                      literature: ipsilateral 65 $\%,$ 54 $\%,$ 23 $\%,$ 11 $\%;$
                      contralateral 25 $\%,$ 16 $\%,$ 6 $\%,$ 3 $\%.$ For
                      lateralized tumors not affecting the midline (N = 143),
                      contralateral involvement was 11 $\%,$ 4 $\%,$ 1 $\%$ 1
                      $\%.$ When contralateral LNL II was negative (N = 291),
                      involvement of downstream LNLs III, IV, V was 5 $\%,$ 3
                      $\%,$ 1 $\%.$ Ipsilateral LNL IV involvement was reduced to
                      7 $\%$ in patients with negative LNL II and III.Ipsilateral
                      level I and VII involvement was 6 $\%$ and 13 $\%$ in
                      T4-tumors, but only 2 $\%$ and 3 $\%$ in T1-T3 tumors.We
                      provide detailed information about lymphatic spread patterns
                      of hypopharyngeal SCC, where subgroups of patients may be
                      identified in whom the ENI may be reduced. For lateralized
                      tumors, contralateral irradiation may be limited to LNL II
                      in patients without contralateral involvement.},
      keywords     = {Hypopharynx (Other) / Lymphatic metastasis (Other) /
                      Squamous cell carcinoma (Other)},
      cin          = {FR01},
      ddc          = {610},
      cid          = {I:(DE-He78)FR01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41319718},
      doi          = {10.1016/j.radonc.2025.111319},
      url          = {https://inrepo02.dkfz.de/record/306676},
}