Principles and paradigms of de-escalated elective nodal irradiation: Boldly going towards an inflection point in head and neck radiotherapy Review
| Authors: | Safavi, A. H.; Lee, N. Y.; Tsai, C. J. |
| Review Title: | Principles and paradigms of de-escalated elective nodal irradiation: Boldly going towards an inflection point in head and neck radiotherapy |
| Abstract: | Fundamental axioms of elective nodal irradiation (ENI) for head and neck cancers merit re-examination in contemporary practice. Standard ENI doses to volumes bordering critical organs-at-risk increased during the transition from two-dimensional radiation planning to intensity-modulated radiotherapy, despite improvements in detection of occult nodal metastases with modern imaging, use of concurrent chemotherapy, and identification of human papillomavirus (HPV)-related radiosensitivity. Historical large ENI volumes covering low-risk nodal regions continue to be commonly used even as awareness grows regarding the predominant pattern-of-failure within existing gross disease. In this review, we outline principles for de-escalating head and neck ENI dose and volume and highlight the emerging paradigm of ENI omission. We also propose a three-part approach to ENI de-escalation, the rationale for early adoption of de-escalated ENI in the absence of level-one evidence, and strategies to promote early adoption in light of modest equipoise and an inflection point towards changing the status quo. © 2025 |
| Keywords: | controlled study; review; intensity modulated radiation therapy; lymph node metastasis; lymph nodes; lymphatic metastasis; radiotherapy dosage; radiotherapy; diagnostic imaging; radiation response; head and neck cancer; head and neck neoplasms; radiotherapy, intensity-modulated; lymph node; diagnosis; irradiation; radiosensitivity; neck; radiotherapy planning, computer-assisted; awareness; head and neck tumor; lymphatic irradiation; procedures; organs at risk; humans; human; radiotherapy planning system; equipoise |
| Journal Title: | Seminars in Radiation Oncology |
| Volume: | 35 |
| Issue: | 2 |
| ISSN: | 1053-4296 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2025-04-01 |
| Start Page: | 143 |
| End Page: | 156 |
| Language: | English |
| DOI: | 10.1016/j.semradonc.2025.01.001 |
| PUBMED: | 40090741 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Review -- Source: Scopus |
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