Level I evidence.
Top Line: Irradiation of level IB obliterates the submandibular gland, a critical contributor to unstimulated saliva.
The Study: So we should think long and hard about when we really need to include it in our radiation volumes. This retrospective review of patients with nasopharyngeal cancer with high risk for level Ib microscopic disease (read: level IIA nodal disease ≥2 cm and / or extracapsular extension) compared outcomes across 169 propensity score-matched pairs who did versus did not have level IB targeted. The rate of level Ib failure at a median follow-up of nearly 10 years was 1.2% after level Ib-irradiation versus 1.8% without. As expected, there was also no significant difference in other disease and survival outcomes. However, the incidence of any dry mouth at 5 years was higher after level Ib-irradiation (28%) than without (17%). Another study back in 2021 performed a detailed analysis of cervical lymph node level involvement. Ib was infrequently involved with a higher risk when an adjacent level and multiple other levels were involved.
TBL: This retrospective study suggests that omitting elective coverage of level IB for node positive NPC results in a low risk of IB failure while decreasing the rate of xerostomia. | Wang, Radiother Oncol 2022
🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖🎖
ReplyDeleteMy Name is Pedro from the United States, I want to say thank you to Mr Mark Toray for the good thing he has done for me, Though am not sure if this is the best forum to show my joy and happiness for what he has done for me but I can’t hide my happiness and my joy so I have to share it with people. This is unbelievable, at first I never actually built any interest in this Binary/Forex trading of a thing but when I later gave it a try with the Help of this wonderful Expert Trader Mr Mark Toray, it was a successful trade for me. All I did was to invest $1000 into my first trading and to my greatest surprise, I received a huge amount of $12,520 as profit in 7 days of trading… Mr Mark Toray was the trader that made it possible and he is still doing it all for me.. You want to be happy and be free like me do well to reach out to her via Email: Marktoray8@gmail.com or Telegram: @Mark4toray_fx