Elective upper-neck versus whole-neck irradiation of the uninvolved neck in patients with nasopharyngeal carcinoma: an open-label, non-inferiority, multicentre, randomised phase 3 trial
The aim of this trial was to address whether elective ipsilateral upper-neck irradiation (UNI) sparing the uninvolved lower neck provides similar regional relapse-free survival compared with standard whole-neck irradiation (WNI) in patients with nasopharyngeal carcinoma. This open-label, non-inferio...
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| Veröffentlicht in: | The lancet oncology 2022-04, Vol.23 (4), p.479-490 |
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| creator | Tang, Ling-Long Huang, Cheng-Long Zhang, Ning Jiang, Wei Wu, Yi-Shan Huang, Shao Hui Mao, Yan-Ping Liu, Qing Li, Ji-Bin Liang, Shao-Qiang Qin, Guan-Jie Hu, Wei-Han Sun, Ying Xie, Fang-Yun Chen, Lei Zhou, Guan-Qun Ma, Jun |
| description | The aim of this trial was to address whether elective ipsilateral upper-neck irradiation (UNI) sparing the uninvolved lower neck provides similar regional relapse-free survival compared with standard whole-neck irradiation (WNI) in patients with nasopharyngeal carcinoma.
This open-label, non-inferiority, randomised, controlled, phase 3 trial was done at three Chinese medical centres. Patients aged 18–65 years with untreated, non-keratinising, non-distant metastatic (M0) nasopharyngeal carcinoma; with N0–N1 disease (according to International Union Against Cancer–American Joint Committee on Cancer TNM classification, seventh edition); and a Karnofsky performance status score of 70 or higher were randomly assigned (1:1) to receive elective UNI or WNI of the uninvolved neck. Total radiation doses of 70 Gy (for the primary tumour volume and the enlarged retropharyngeal nodes), 66–70 Gy (for the involved cervical lymph nodes), 60–62 Gy (for the high-risk target volume), and 54–56 Gy (for the low-risk target volume) were administered in 30–33 fractions, five fractions per week. Patients with stage II–IVA disease were recommended to receive combined intravenous cisplatin-based chemotherapy (either induction chemotherapy followed by concurrent chemoradiotherapy or concurrent chemoradiotherapy alone). Randomisation was done centrally by the Clinical Trials Centre of Sun Yat-sen University Cancer Centre by means of a computer-generated random number code with a block size of four. Patients were stratified according to treatment centre and nodal status. Investigators and patients were not masked to treatment allocation. The primary endpoint was regional relapse-free survival in the intention-to-treat population. Non-inferiority was indicated if the upper limit of the 95% CI of the difference in 3-year regional relapse-free survival between the UNI and WNI groups was within 8%. Adverse events were analysed in the safety population (defined as all patients who commenced the randomly assigned treatment). This study is registered with ClinicalTrials.gov, NCT02642107, and is closed.
Between Jan 22, 2016, and May 23, 2018, 446 patients from 469 screened were randomly assigned to receive UNI (n=224) or WNI (n=222). Median follow-up was 53 months (IQR 46–59). 3-year regional relapse-free survival was similar in the UNI and WNI groups (97·7% [95% CI 95·7–99·7] in the UNI group vs 96·3% [93·8–98·8] in the WNI group; difference −1·4% [95% CI −4·6 to 1·8]; pnon-inferiority |
| doi_str_mv | 10.1016/S1470-2045(22)00058-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2644337003</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1470204522000584</els_id><sourcerecordid>2644337003</sourcerecordid><originalsourceid>FETCH-LOGICAL-c393t-6df58a562a66dd33de5b141017b32e83be7e8d63cadefdb162e7f318f08f31413</originalsourceid><addsrcrecordid>eNqFkc1u1TAQhS1ERUvhEUCW2IB0A_7LD90gVBWKVIkFsLYce8J1SexgO6n6aLwd05vSLasZjb5zRjOHkBecveWMN---cdWySjBVvxbiDWOs7ir1iJzgWFW16rrHh35DjsnTnK8Z4y1n9RNyLGuhUCFPyJ-LEWzxK9BlniFVAewvukLKS6Y3-zjCNvEpGedN8THQONCyRz74sMZxBUc3JNAZAQgFlb7saTA5znuTbsNPMCO1Jlkf4mTOqEGTGUI1mh7GHQ0xVD4MkHxMvtzu6LSMxVt0SrCjyQQXJ59xD7ploJKW5M34jBwNZszw_L6ekh-fLr6fX1ZXXz9_Of94VVn5XpaqcUPdmboRpmmck9JB3XOFL2x7KaCTPbTQuUZa42BwPW8EtIPk3cA6LIrLU_Jq851T_L1ALvo6LingSi0apaRsGZNI1RtlU8w5waDn5Cc8XnOm7wLTh8D0XRpaCH0ITCvUvbx3X_oJ3IPqX0IIfNgAwBtXD0lni0-24HzC5LSL_j8r_gJ2TKmB</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2644337003</pqid></control><display><type>article</type><title>Elective upper-neck versus whole-neck irradiation of the uninvolved neck in patients with nasopharyngeal carcinoma: an open-label, non-inferiority, multicentre, randomised phase 3 trial</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Tang, Ling-Long ; Huang, Cheng-Long ; Zhang, Ning ; Jiang, Wei ; Wu, Yi-Shan ; Huang, Shao Hui ; Mao, Yan-Ping ; Liu, Qing ; Li, Ji-Bin ; Liang, Shao-Qiang ; Qin, Guan-Jie ; Hu, Wei-Han ; Sun, Ying ; Xie, Fang-Yun ; Chen, Lei ; Zhou, Guan-Qun ; Ma, Jun</creator><creatorcontrib>Tang, Ling-Long ; Huang, Cheng-Long ; Zhang, Ning ; Jiang, Wei ; Wu, Yi-Shan ; Huang, Shao Hui ; Mao, Yan-Ping ; Liu, Qing ; Li, Ji-Bin ; Liang, Shao-Qiang ; Qin, Guan-Jie ; Hu, Wei-Han ; Sun, Ying ; Xie, Fang-Yun ; Chen, Lei ; Zhou, Guan-Qun ; Ma, Jun</creatorcontrib><description>The aim of this trial was to address whether elective ipsilateral upper-neck irradiation (UNI) sparing the uninvolved lower neck provides similar regional relapse-free survival compared with standard whole-neck irradiation (WNI) in patients with nasopharyngeal carcinoma.
This open-label, non-inferiority, randomised, controlled, phase 3 trial was done at three Chinese medical centres. Patients aged 18–65 years with untreated, non-keratinising, non-distant metastatic (M0) nasopharyngeal carcinoma; with N0–N1 disease (according to International Union Against Cancer–American Joint Committee on Cancer TNM classification, seventh edition); and a Karnofsky performance status score of 70 or higher were randomly assigned (1:1) to receive elective UNI or WNI of the uninvolved neck. Total radiation doses of 70 Gy (for the primary tumour volume and the enlarged retropharyngeal nodes), 66–70 Gy (for the involved cervical lymph nodes), 60–62 Gy (for the high-risk target volume), and 54–56 Gy (for the low-risk target volume) were administered in 30–33 fractions, five fractions per week. Patients with stage II–IVA disease were recommended to receive combined intravenous cisplatin-based chemotherapy (either induction chemotherapy followed by concurrent chemoradiotherapy or concurrent chemoradiotherapy alone). Randomisation was done centrally by the Clinical Trials Centre of Sun Yat-sen University Cancer Centre by means of a computer-generated random number code with a block size of four. Patients were stratified according to treatment centre and nodal status. Investigators and patients were not masked to treatment allocation. The primary endpoint was regional relapse-free survival in the intention-to-treat population. Non-inferiority was indicated if the upper limit of the 95% CI of the difference in 3-year regional relapse-free survival between the UNI and WNI groups was within 8%. Adverse events were analysed in the safety population (defined as all patients who commenced the randomly assigned treatment). This study is registered with ClinicalTrials.gov, NCT02642107, and is closed.
Between Jan 22, 2016, and May 23, 2018, 446 patients from 469 screened were randomly assigned to receive UNI (n=224) or WNI (n=222). Median follow-up was 53 months (IQR 46–59). 3-year regional relapse-free survival was similar in the UNI and WNI groups (97·7% [95% CI 95·7–99·7] in the UNI group vs 96·3% [93·8–98·8] in the WNI group; difference −1·4% [95% CI −4·6 to 1·8]; pnon-inferiority<0·0001). Although acute radiation-related toxic effects were similar between the groups, the incidence of late toxicity was lower in the UNI group than in the WNI group, including any-grade hypothyroidism (66 [30%] of 222 patients vs 87 [39%] of 221), skin toxicity (32 [14%] vs 55 [25%]), dysphagia (38 [17%] vs 71 [32%]), and neck tissue damage (50 [23%] vs 88 [40%]). No patients died during treatment. After treatment, one patient in the WNI group died from a non-cancer-related cause (dermatomyositis).
Elective UNI of the uninvolved neck provides similar regional control and results in less radiation toxicity compared with standard WNI in patients with N0–N1 nasopharyngeal carcinoma.
Sun Yat-sen University Clinical Research 5010 Program, the Natural Science Foundation of Guangdong Province, and the Overseas Expertise Introduction Project for Discipline Innovation.
For the Chinese translation of the abstract see Supplementary Materials section.</description><identifier>ISSN: 1470-2045</identifier><identifier>EISSN: 1474-5488</identifier><identifier>DOI: 10.1016/S1470-2045(22)00058-4</identifier><identifier>PMID: 35240053</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Adolescent ; Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Cancer ; Chemoradiotherapy ; Chemoradiotherapy - adverse effects ; Chemoradiotherapy - methods ; Chemotherapy ; Cisplatin ; Clinical trials ; Dermatomyositis ; Dysphagia ; Epstein-Barr virus ; Hematology ; Humans ; Hypothyroidism ; Intravenous administration ; Lymph nodes ; Lymphatic system ; Metastases ; Metastasis ; Middle Aged ; Nasopharyngeal carcinoma ; Nasopharyngeal Carcinoma - drug therapy ; Nasopharyngeal Carcinoma - radiotherapy ; Nasopharyngeal Neoplasms - pathology ; Neck ; Neoplasm Recurrence, Local - pathology ; Neoplasm Staging ; Patients ; Quality of life ; Radiation ; Radiation therapy ; Spinal cord ; Survival ; Throat cancer ; Toxicity ; Translation ; Tumors ; Young Adult</subject><ispartof>The lancet oncology, 2022-04, Vol.23 (4), p.479-490</ispartof><rights>2022 Elsevier Ltd</rights><rights>Copyright © 2022 Elsevier Ltd. All rights reserved.</rights><rights>2022. Elsevier Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c393t-6df58a562a66dd33de5b141017b32e83be7e8d63cadefdb162e7f318f08f31413</citedby><cites>FETCH-LOGICAL-c393t-6df58a562a66dd33de5b141017b32e83be7e8d63cadefdb162e7f318f08f31413</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1470204522000584$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35240053$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tang, Ling-Long</creatorcontrib><creatorcontrib>Huang, Cheng-Long</creatorcontrib><creatorcontrib>Zhang, Ning</creatorcontrib><creatorcontrib>Jiang, Wei</creatorcontrib><creatorcontrib>Wu, Yi-Shan</creatorcontrib><creatorcontrib>Huang, Shao Hui</creatorcontrib><creatorcontrib>Mao, Yan-Ping</creatorcontrib><creatorcontrib>Liu, Qing</creatorcontrib><creatorcontrib>Li, Ji-Bin</creatorcontrib><creatorcontrib>Liang, Shao-Qiang</creatorcontrib><creatorcontrib>Qin, Guan-Jie</creatorcontrib><creatorcontrib>Hu, Wei-Han</creatorcontrib><creatorcontrib>Sun, Ying</creatorcontrib><creatorcontrib>Xie, Fang-Yun</creatorcontrib><creatorcontrib>Chen, Lei</creatorcontrib><creatorcontrib>Zhou, Guan-Qun</creatorcontrib><creatorcontrib>Ma, Jun</creatorcontrib><title>Elective upper-neck versus whole-neck irradiation of the uninvolved neck in patients with nasopharyngeal carcinoma: an open-label, non-inferiority, multicentre, randomised phase 3 trial</title><title>The lancet oncology</title><addtitle>Lancet Oncol</addtitle><description>The aim of this trial was to address whether elective ipsilateral upper-neck irradiation (UNI) sparing the uninvolved lower neck provides similar regional relapse-free survival compared with standard whole-neck irradiation (WNI) in patients with nasopharyngeal carcinoma.
This open-label, non-inferiority, randomised, controlled, phase 3 trial was done at three Chinese medical centres. Patients aged 18–65 years with untreated, non-keratinising, non-distant metastatic (M0) nasopharyngeal carcinoma; with N0–N1 disease (according to International Union Against Cancer–American Joint Committee on Cancer TNM classification, seventh edition); and a Karnofsky performance status score of 70 or higher were randomly assigned (1:1) to receive elective UNI or WNI of the uninvolved neck. Total radiation doses of 70 Gy (for the primary tumour volume and the enlarged retropharyngeal nodes), 66–70 Gy (for the involved cervical lymph nodes), 60–62 Gy (for the high-risk target volume), and 54–56 Gy (for the low-risk target volume) were administered in 30–33 fractions, five fractions per week. Patients with stage II–IVA disease were recommended to receive combined intravenous cisplatin-based chemotherapy (either induction chemotherapy followed by concurrent chemoradiotherapy or concurrent chemoradiotherapy alone). Randomisation was done centrally by the Clinical Trials Centre of Sun Yat-sen University Cancer Centre by means of a computer-generated random number code with a block size of four. Patients were stratified according to treatment centre and nodal status. Investigators and patients were not masked to treatment allocation. The primary endpoint was regional relapse-free survival in the intention-to-treat population. Non-inferiority was indicated if the upper limit of the 95% CI of the difference in 3-year regional relapse-free survival between the UNI and WNI groups was within 8%. Adverse events were analysed in the safety population (defined as all patients who commenced the randomly assigned treatment). This study is registered with ClinicalTrials.gov, NCT02642107, and is closed.
Between Jan 22, 2016, and May 23, 2018, 446 patients from 469 screened were randomly assigned to receive UNI (n=224) or WNI (n=222). Median follow-up was 53 months (IQR 46–59). 3-year regional relapse-free survival was similar in the UNI and WNI groups (97·7% [95% CI 95·7–99·7] in the UNI group vs 96·3% [93·8–98·8] in the WNI group; difference −1·4% [95% CI −4·6 to 1·8]; pnon-inferiority<0·0001). Although acute radiation-related toxic effects were similar between the groups, the incidence of late toxicity was lower in the UNI group than in the WNI group, including any-grade hypothyroidism (66 [30%] of 222 patients vs 87 [39%] of 221), skin toxicity (32 [14%] vs 55 [25%]), dysphagia (38 [17%] vs 71 [32%]), and neck tissue damage (50 [23%] vs 88 [40%]). No patients died during treatment. After treatment, one patient in the WNI group died from a non-cancer-related cause (dermatomyositis).
Elective UNI of the uninvolved neck provides similar regional control and results in less radiation toxicity compared with standard WNI in patients with N0–N1 nasopharyngeal carcinoma.
Sun Yat-sen University Clinical Research 5010 Program, the Natural Science Foundation of Guangdong Province, and the Overseas Expertise Introduction Project for Discipline Innovation.
For the Chinese translation of the abstract see Supplementary Materials section.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>Cancer</subject><subject>Chemoradiotherapy</subject><subject>Chemoradiotherapy - adverse effects</subject><subject>Chemoradiotherapy - methods</subject><subject>Chemotherapy</subject><subject>Cisplatin</subject><subject>Clinical trials</subject><subject>Dermatomyositis</subject><subject>Dysphagia</subject><subject>Epstein-Barr virus</subject><subject>Hematology</subject><subject>Humans</subject><subject>Hypothyroidism</subject><subject>Intravenous administration</subject><subject>Lymph nodes</subject><subject>Lymphatic system</subject><subject>Metastases</subject><subject>Metastasis</subject><subject>Middle Aged</subject><subject>Nasopharyngeal carcinoma</subject><subject>Nasopharyngeal Carcinoma - drug therapy</subject><subject>Nasopharyngeal Carcinoma - radiotherapy</subject><subject>Nasopharyngeal Neoplasms - pathology</subject><subject>Neck</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Neoplasm Staging</subject><subject>Patients</subject><subject>Quality of life</subject><subject>Radiation</subject><subject>Radiation therapy</subject><subject>Spinal cord</subject><subject>Survival</subject><subject>Throat cancer</subject><subject>Toxicity</subject><subject>Translation</subject><subject>Tumors</subject><subject>Young 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Cheng-Long ; Zhang, Ning ; Jiang, Wei ; Wu, Yi-Shan ; Huang, Shao Hui ; Mao, Yan-Ping ; Liu, Qing ; Li, Ji-Bin ; Liang, Shao-Qiang ; Qin, Guan-Jie ; Hu, Wei-Han ; Sun, Ying ; Xie, Fang-Yun ; Chen, Lei ; Zhou, Guan-Qun ; Ma, Jun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c393t-6df58a562a66dd33de5b141017b32e83be7e8d63cadefdb162e7f318f08f31413</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>Cancer</topic><topic>Chemoradiotherapy</topic><topic>Chemoradiotherapy - adverse effects</topic><topic>Chemoradiotherapy - methods</topic><topic>Chemotherapy</topic><topic>Cisplatin</topic><topic>Clinical trials</topic><topic>Dermatomyositis</topic><topic>Dysphagia</topic><topic>Epstein-Barr 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Guan-Jie</au><au>Hu, Wei-Han</au><au>Sun, Ying</au><au>Xie, Fang-Yun</au><au>Chen, Lei</au><au>Zhou, Guan-Qun</au><au>Ma, Jun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Elective upper-neck versus whole-neck irradiation of the uninvolved neck in patients with nasopharyngeal carcinoma: an open-label, non-inferiority, multicentre, randomised phase 3 trial</atitle><jtitle>The lancet oncology</jtitle><addtitle>Lancet Oncol</addtitle><date>2022-04</date><risdate>2022</risdate><volume>23</volume><issue>4</issue><spage>479</spage><epage>490</epage><pages>479-490</pages><issn>1470-2045</issn><eissn>1474-5488</eissn><abstract>The aim of this trial was to address whether elective ipsilateral upper-neck irradiation (UNI) sparing the uninvolved lower neck provides similar regional relapse-free survival compared with standard whole-neck irradiation (WNI) in patients with nasopharyngeal carcinoma.
This open-label, non-inferiority, randomised, controlled, phase 3 trial was done at three Chinese medical centres. Patients aged 18–65 years with untreated, non-keratinising, non-distant metastatic (M0) nasopharyngeal carcinoma; with N0–N1 disease (according to International Union Against Cancer–American Joint Committee on Cancer TNM classification, seventh edition); and a Karnofsky performance status score of 70 or higher were randomly assigned (1:1) to receive elective UNI or WNI of the uninvolved neck. Total radiation doses of 70 Gy (for the primary tumour volume and the enlarged retropharyngeal nodes), 66–70 Gy (for the involved cervical lymph nodes), 60–62 Gy (for the high-risk target volume), and 54–56 Gy (for the low-risk target volume) were administered in 30–33 fractions, five fractions per week. Patients with stage II–IVA disease were recommended to receive combined intravenous cisplatin-based chemotherapy (either induction chemotherapy followed by concurrent chemoradiotherapy or concurrent chemoradiotherapy alone). Randomisation was done centrally by the Clinical Trials Centre of Sun Yat-sen University Cancer Centre by means of a computer-generated random number code with a block size of four. Patients were stratified according to treatment centre and nodal status. Investigators and patients were not masked to treatment allocation. The primary endpoint was regional relapse-free survival in the intention-to-treat population. Non-inferiority was indicated if the upper limit of the 95% CI of the difference in 3-year regional relapse-free survival between the UNI and WNI groups was within 8%. Adverse events were analysed in the safety population (defined as all patients who commenced the randomly assigned treatment). This study is registered with ClinicalTrials.gov, NCT02642107, and is closed.
Between Jan 22, 2016, and May 23, 2018, 446 patients from 469 screened were randomly assigned to receive UNI (n=224) or WNI (n=222). Median follow-up was 53 months (IQR 46–59). 3-year regional relapse-free survival was similar in the UNI and WNI groups (97·7% [95% CI 95·7–99·7] in the UNI group vs 96·3% [93·8–98·8] in the WNI group; difference −1·4% [95% CI −4·6 to 1·8]; pnon-inferiority<0·0001). Although acute radiation-related toxic effects were similar between the groups, the incidence of late toxicity was lower in the UNI group than in the WNI group, including any-grade hypothyroidism (66 [30%] of 222 patients vs 87 [39%] of 221), skin toxicity (32 [14%] vs 55 [25%]), dysphagia (38 [17%] vs 71 [32%]), and neck tissue damage (50 [23%] vs 88 [40%]). No patients died during treatment. After treatment, one patient in the WNI group died from a non-cancer-related cause (dermatomyositis).
Elective UNI of the uninvolved neck provides similar regional control and results in less radiation toxicity compared with standard WNI in patients with N0–N1 nasopharyngeal carcinoma.
Sun Yat-sen University Clinical Research 5010 Program, the Natural Science Foundation of Guangdong Province, and the Overseas Expertise Introduction Project for Discipline Innovation.
For the Chinese translation of the abstract see Supplementary Materials section.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>35240053</pmid><doi>10.1016/S1470-2045(22)00058-4</doi><tpages>12</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1470-2045 |
| ispartof | The lancet oncology, 2022-04, Vol.23 (4), p.479-490 |
| issn | 1470-2045 1474-5488 |
| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adolescent Adult Aged Antineoplastic Combined Chemotherapy Protocols - therapeutic use Cancer Chemoradiotherapy Chemoradiotherapy - adverse effects Chemoradiotherapy - methods Chemotherapy Cisplatin Clinical trials Dermatomyositis Dysphagia Epstein-Barr virus Hematology Humans Hypothyroidism Intravenous administration Lymph nodes Lymphatic system Metastases Metastasis Middle Aged Nasopharyngeal carcinoma Nasopharyngeal Carcinoma - drug therapy Nasopharyngeal Carcinoma - radiotherapy Nasopharyngeal Neoplasms - pathology Neck Neoplasm Recurrence, Local - pathology Neoplasm Staging Patients Quality of life Radiation Radiation therapy Spinal cord Survival Throat cancer Toxicity Translation Tumors Young Adult |
| title | Elective upper-neck versus whole-neck irradiation of the uninvolved neck in patients with nasopharyngeal carcinoma: an open-label, non-inferiority, multicentre, randomised phase 3 trial |
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