De-escalating elective nodal irradiation dose to 45 Gy in nasopharyngeal carcinoma: A large-cohort study with 5-year outcomes
In brief
45-Gy nodal radiation was followed by 97.3% 5-year regional control
In a real-world cohort of 752 patients with nonmetastatic nasopharyngeal cancer, regional control was 97.3% at 5 years; only 0.7% had isolated failures within the 45-Gy treated volume. Replanning suggested lower doses to nearby organs and reduced modeled risks of parotid dysfunction, swallowing problems, and hypothyroidism, but prospective studies are needed to confirm the benefits.
- Journal
- Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology (Q1)
- Published
- 25 September 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Xinlan Chen, Yuan Huang, Kexin Lin, Jihong Chen, Yedong Huang, Yahan Zheng, et al.
- PMID
- 42790787
- DOI
- 10.1016/j.radonc.2026.111795
Why clinicians should know about it
- Picked for Medical Physics (top studies of the week, 27 September 2026): High-quality evidence in a top journal
Abstract
PURPOSE: Although recent guidelinesrecommend de-escalatedelective nodal irradiation (ENI) for nasopharyngeal carcinoma (NPC), the optimal dose remains undefined (45-52.6 Gy dose in 2 Gy fractions, EQD2). Weevaluated the long-term efficacy of 45-Gy EQD2 ENI dose in a real-world cohortto inform dose optimization and guideline refinement. MATERIALS AND METHODS: Newly diagnosed, non-metastatic NPC patients treated with intensity-modulated radiotherapy (IMRT) and received 45-Gy EQD2 ENI dose at our institution were screened. Regional control (RC), overall survival (OS), local control (LC), and distant control (DC)were evaluated. Dosimetric comparisons between 45-Gy and 50-Gy EQD2 plans were performed on 20 randomly selected replanned cases using identical target volumes and organs at risk (OARs) constraints. Normal tissue complication probability (NTCP) rates for major toxicities were derived to predict clinical benefit. RESULTS: Totally,752 patients were included. With a median follow-up of 68 months, the 5-year RC, LC, DC, and OS rates were 97.3 %, 96.1 %, 90.6 %, and 89.7 %, respectively. Regional recurrence occurred in 23 patients; 14 were within the nodal clinical target volume, including 11 in-situ nodal gross target volume relapses and five isolated failures (0.7 %) within the 45-Gy volume. The 45-Gy EQD2 plan significantly reduced dose to all relevant OARs (P < 0.001) compared with 50-Gy EQD2 plan. Significant median NTCP reductions were observed for parotid gland function loss, dysphagia and hypothyroidism (all P < 0.001). CONCLUSION: A 45-Gy EQD2 ENI dose provides favorable long-termefficacywith superior OAR sparing and reduced NTCP, supporting further prospective evaluation of this de-escalation strategy in NPC.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.