Upfront Neck Dissection Before Radiotherapy in Stage N3 Nasopharyngeal Carcinoma: A Retrospective Study

Nasopharyngeal carcinoma (NPC), due to its anatomical proximity to the skull base and critical cervical structures, is primarily treated with radiotherapy. However, even with current standard treatments, a subset of patients still develop locoregional failure with poor outcomes. Previous data have shown that the 5-year locoregional control rate for stage IV disease is approximately 80.7%, corresponding to a failure rate of about 20%. Among these, patients with T1-4N3 disease have a lower 3-year distant failure-free survival compared with T4N0-2, indicating that high N stage is associated not only with regional recurrence but also with increased risk of distant metastasis. Based on this, we hypothesize that high nodal burden and high-risk imaging features are significantly associated with cervical recurrence and distant metastasis, and that appropriate and timely salvage treatment to the neck (such as neck dissection with or without re-irradiation/systemic therapy) may improve regional control and survival.

Inclusion criteria

• Age ≥ 18 years.
• Pathologically confirmed diagnosis of nasopharyngeal carcinoma (NPC).
• Stage IV disease (Tany N3) according to the 8th edition of the AJCC staging system.
• Completion of definitive concurrent chemoradiotherapy (CCRT), or induction chemotherapy (IC) followed by radiotherapy/CCRT.
• Availability of complete clinical imaging and medical records before and after treatment for efficacy and prognostic analysis.

Exclusion criteria

• Presence of distant metastasis at initial diagnosis.
• Prior history of treatment for other head and neck malignancies, aside from definitive therapy for NPC (to avoid confounding prognosis).
• Incomplete or prematurely discontinued definitive radiotherapy, resulting in failure to complete the planned curative treatment.
• Lack of complete pathology report, clinical imaging, or treatment records, making effective analysis impossible.