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| Home > Publications database > Medial retropharyngeal lymph node involvement in nasopharyngeal cancer patients treated with radiotherapy in Germany - A multicenter analysis. |
| Home > Publications database > Medial retropharyngeal lymph node involvement in nasopharyngeal cancer patients treated with radiotherapy in Germany - A multicenter analysis. |
| Journal Article | DKFZ-2026-01714 |
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2026
Elsevier Science
Amsterdam [u.a.]
Abstract: Prospective studies have demonstrated that involvement of medial retropharyngeal lymph nodes (MRLN) in endemic nasopharyngeal carcinoma (NPC) is rare, with a frequency below 1%. On this basis, a randomized trial demonstrated the oncological safety and improved quality of life after omission of radiotherapy (RT) to the MRLN in definitive chemoradiotherapy (CRT). Here, we evaluate the rate of MRLN involvement within a non-endemic cohort of NPC patients treated with RT/CRT in Germany.The MERLIN study (jARO-v-2025-05; DRKS00034782) is a retrospective multicenter study organized by the young DEGRO trial group. Patient inclusion required sufficient imaging and histologically proven NPC, treated with RT or CRT. Central review of cases, in which MRLN involvement was suspected, was performed by a board-certified radiologist and radiation oncologist.We evaluated 305 patients from 9 centers treated between 2004 and 2023. Patients were treated with CRT (n = 277, 90.8%) or RT alone (n = 28, 9.1%). Neoadjuvant chemotherapy was applied in 18.2% (55/302) of patients. MRLN involvement was suspected in 21 cases. Central review confirmed MRLN involvement in nine patients, yielding a total rate of 2.95% (9/305) across all patients. In 70.2% (198/282) of patients, MRLN were included in the clinical target volume. Only one recurrence occurred in the medial retropharyngeal space, despite prior MRLN irradiation and no baseline MRLN involvement.While involvement of MRLN was higher compared with cohorts from NPC-endemic regions, recurrence in MRLN was a rare event. After careful staging, omission of elective MRLN irradiation appears safe in NPC patients from non-endemic regions.
Keyword(s): Clinical target volume delineation ; Elective nodal irradiation ; Non-endemic nasopharyngeal carcinoma ; Radiation treatment planning
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